S Misra Department of Surgical Oncology King George's Medical University Lucknow
Source of Support: None, Conflict of Interest: None
Gallbladder carcinoma is one of the commonest cancers seen in North India. Surgical resection has been looked at with pessimism due to the poor results reported in the literature. However, the last decade has seen major progress in the surgical treatment of this disease. This opinion based review is based on the available literature and our own experience of radical surgical procedures. The curative surgery for carcinoma gallbladder has ranged from simple cholecystectomy to radical cholecystectomy to supraradical surgery like hepatopancreatico-duodenectomy. Laparoscopic cholecystectomy should not be done if gallbladder carcinoma is suspected preoperatively. Patients who have inadvertently undergone laparoscopic cholecystectomy require re-exploration and port sites resection in addition to radical cholecystectomy. Patients with Tis and T1a disease are cured with simple cholecystectomy (5 year survival 85-100 percent). Cancers T1b and beyond are best treated with radical cholecystectomy. Patients with T2 cancer have a 61-90 percent 5 year survival with radical surgery. Survival of patients with T3, T4 tumours are poor compared to early stage disease. Encouraging 5-years survivals of 15 to 63 percent and 7 to 25 percent have been reported recently for T3 and T4 tumours, respectively. Debulking surgery has no proven value and is not recommended. Radical resection remains the only potentially curative treatment. Future studies will see the better integration of radical surgery with adjuvant and neoadjuvant treatment in improving survival in gallbladder carcinoma.