Gallbladder cancer surgery: Difference between revisions

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{{Gallbladder cancer}}
{{Gallbladder cancer}}
{{CMG}}
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==Overview==
==Overview==
[[Surgery]] is the only mainstay of treatment for [[gallbladder cancer]]. Complete surgical tumour [[resection]] is the only curative treatment for the gallbladder cancer.[[Radical (chemistry)|Radical]] [[cholecystectomy]] and extended radical [[cholecystectomy]] are the surgery of choice for [[gallbladder cancer]].


==Surgery==
==Surgery==
* Complete surgical tumour [[resection]] is the only [[Cure|curative]] treatment but is mostly challenging because of the [[Anatomy|anatomical]] position of the [[gallbladder]].
* Glenn and Hays  was first proposed <nowiki>''</nowiki>''[[Radical (chemistry)|radical]] [[cholecystectomy]]''<nowiki>''</nowiki> in 1954 in which along with the gallbladder a small rim of the liver [[parenchyma]] and [[lymphatic]] tissue were excised <ref name="pmid20077022">{{cite journal |vauthors=Sakata J, Shirai Y, Wakai T, Ajioka Y, Hatakeyama K |title=Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma |journal=Ann. Surg. Oncol. |volume=17 |issue=7 |pages=1831–40 |year=2010 |pmid=20077022 |doi=10.1245/s10434-009-0899-1 |url=}}</ref>
* in 1982 An “extended radical [[cholecystectomy]]” was proposed in which [[lymphatic tissue]], posterosuperior head of the [[pancreas]], [[common hepatic artery]], [[gallbladder]] and a rim of liver parenchyma are excised
* During the surgery [[morbidity]] and [[Mortality rate|mortality]] were increased by incising the gallbladder or spilling its contents.
* Generally open procedure is recommended rather than [[laparoscopic]] procedure<ref name="pmid11986018">{{cite journal |vauthors=Weiland ST, Mahvi DM, Niederhuber JE, Heisey DM, Chicks DS, Rikkers LF |title=Should suspected early gallbladder cancer be treated laparoscopically? |journal=J. Gastrointest. Surg. |volume=6 |issue=1 |pages=50–6; discussion 56–7 |year=2002 |pmid=11986018 |doi= |url=}}</ref>


Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.
=== '''T1 stage gallbladder cancer''' ===
*'''T1a''':Simple [[cholecystectomy]] alone is idle surgery of choice.<ref name="pmid8790169">{{cite journal |vauthors=Yamaguchi K, Chijiiwa K, Ichimiya H, Sada M, Kawakami K, Nishikata F, Konomi K, Tanaka M |title=Gallbladder carcinoma in the era of laparoscopic cholecystectomy |journal=Arch Surg |volume=131 |issue=9 |pages=981–4; discussion 985 |year=1996 |pmid=8790169 |doi= |url=}}</ref><ref name="pmid12607584">{{cite journal |vauthors=Shoup M, Fong Y |title=Surgical indications and extent of resection in gallbladder cancer |journal=Surg. Oncol. Clin. N. Am. |volume=11 |issue=4 |pages=985–94 |year=2002 |pmid=12607584 |doi= |url=}}</ref>


If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:
* '''T1b''':Rather than simple [[cholecystectomy]] a [[Radical (chemistry)|radical]] approach is more beneficial.
 
=== '''T2 stage gallbladder cancer''' ===
*Extended [[cholecystectomy]] is the idle choice of surgery for patients with T2 stage.<ref name="pmid18722943">{{cite journal |vauthors=Coburn NG, Cleary SP, Tan JC, Law CH |title=Surgery for gallbladder cancer: a population-based analysis |journal=J. Am. Coll. Surg. |volume=207 |issue=3 |pages=371–82 |year=2008 |pmid=18722943 |doi=10.1016/j.jamcollsurg.2008.02.031 |url=}}</ref>
* In stage T2 high rates of local recurrence are noticed and a simple [[cholecystectomy]] should be done.
 
=== '''T3/4''' '''stage gallbladder cancer''' ===
* A [[radical surgery]] in patients with T3 and T4 stage indicating long-term [[Survival rate|survival]].<ref name="pmid10998654">{{cite journal |vauthors=Fong Y, Jarnagin W, Blumgart LH |title=Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention |journal=Ann. Surg. |volume=232 |issue=4 |pages=557–69 |year=2000 |pmid=10998654 |pmc=1421188 |doi= |url=}}</ref>
* It has been reported that a median survival rate  of 17 months with a 2 % mortality rate.
 
=== '''Incidental gallbladder cancer management''' ===
* In patients undergoing [[laparoscopic]] [[cholecystectomy]] incidental [[gallbladder cancer]] was found in 31 of 9497. <ref name="pmid19451486">{{cite journal |vauthors=Konstantinidis IT, Deshpande V, Genevay M, Berger D, Fernandez-del Castillo C, Tanabe KK, Zheng H, Lauwers GY, Ferrone CR |title=Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience |journal=Arch Surg |volume=144 |issue=5 |pages=441–7; discussion 447 |year=2009 |pmid=19451486 |doi=10.1001/archsurg.2009.46 |url=}}</ref>
* The management of incidental gallbladder cancer finding depends upon disease extent at the time of [[diagnosis]].
*Types of surgical interventions are different and can range simple [[cholecystectomy]] to combined with partial [[hepatectomy]], with or without regional [[lymph node]] [[resection]].


Surgical biliary bypass: If the tumor is blocking the small intestine and bile is building up in the gallbladder, a biliary bypass may be done. During this operation, the gallbladder or bile duct will be cut and sewn to the small intestine to create a new pathway around the blocked area.
Endoscopic stent placement: If the tumor is blocking the bile duct, surgery may be done to put in a stent (a thin, flexible tube) to drain bile that has built up in the area. The stent may be placed through a catheter that drains to the outside of the body or the stent may go around the blocked area and drain the bile into the small intestine.
Percutaneous transhepatic biliary drainage: A procedure done to drain bile when there is a blockage and endoscopic stent placement is not possible. An x-ray of the liver and bile ducts is done to locate the blockage. Images made by ultrasound are used to guide placement of a stent, which is left in the liver to drain bile into the small intestine or a collection bag outside the body. This procedure may be done to relieve jaundice before surgery.
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 15:32, 10 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Surgery is the only mainstay of treatment for gallbladder cancer. Complete surgical tumour resection is the only curative treatment for the gallbladder cancer.Radical cholecystectomy and extended radical cholecystectomy are the surgery of choice for gallbladder cancer.

Surgery

T1 stage gallbladder cancer

T2 stage gallbladder cancer

  • Extended cholecystectomy is the idle choice of surgery for patients with T2 stage.[5]
  • In stage T2 high rates of local recurrence are noticed and a simple cholecystectomy should be done.

T3/4 stage gallbladder cancer

  • A radical surgery in patients with T3 and T4 stage indicating long-term survival.[6]
  • It has been reported that a median survival rate of 17 months with a 2 % mortality rate.

Incidental gallbladder cancer management

References

  1. Sakata J, Shirai Y, Wakai T, Ajioka Y, Hatakeyama K (2010). "Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma". Ann. Surg. Oncol. 17 (7): 1831–40. doi:10.1245/s10434-009-0899-1. PMID 20077022.
  2. Weiland ST, Mahvi DM, Niederhuber JE, Heisey DM, Chicks DS, Rikkers LF (2002). "Should suspected early gallbladder cancer be treated laparoscopically?". J. Gastrointest. Surg. 6 (1): 50–6, discussion 56–7. PMID 11986018.
  3. Yamaguchi K, Chijiiwa K, Ichimiya H, Sada M, Kawakami K, Nishikata F, Konomi K, Tanaka M (1996). "Gallbladder carcinoma in the era of laparoscopic cholecystectomy". Arch Surg. 131 (9): 981–4, discussion 985. PMID 8790169.
  4. Shoup M, Fong Y (2002). "Surgical indications and extent of resection in gallbladder cancer". Surg. Oncol. Clin. N. Am. 11 (4): 985–94. PMID 12607584.
  5. Coburn NG, Cleary SP, Tan JC, Law CH (2008). "Surgery for gallbladder cancer: a population-based analysis". J. Am. Coll. Surg. 207 (3): 371–82. doi:10.1016/j.jamcollsurg.2008.02.031. PMID 18722943.
  6. Fong Y, Jarnagin W, Blumgart LH (2000). "Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention". Ann. Surg. 232 (4): 557–69. PMC 1421188. PMID 10998654.
  7. Konstantinidis IT, Deshpande V, Genevay M, Berger D, Fernandez-del Castillo C, Tanabe KK, Zheng H, Lauwers GY, Ferrone CR (2009). "Trends in presentation and survival for gallbladder cancer during a period of more than 4 decades: a single-institution experience". Arch Surg. 144 (5): 441–7, discussion 447. doi:10.1001/archsurg.2009.46. PMID 19451486.


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