J Korean Med Sci.  2014 Oct;29(10):1333-1340. 10.3346/jkms.2014.29.10.1333.

Practical Guidelines for the Surgical Treatment of Gallbladder Cancer

Affiliations
  • 1Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea.
  • 2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
  • 3Department of Surgery, Korea University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Hallym University College of Medicine, Chuncheon, Korea.
  • 5Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea.
  • 6Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.
  • 7Department of Surgery, Kosin University College of Medicine, Busan, Korea.
  • 8Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
  • 9Department of Surgery, Catholic University College of Medicine, Seoul, Korea.
  • 10Department of Surgery, Sungkyunkwan University College of Medicine, Seoul, Korea. dwchoi@skku.edu

Abstract

At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.

Keyword

Gallbladder; Neoplasm; General Surgery; Guideline
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