Gallbladder cancer surgery: Difference between revisions
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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]] 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. | * 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> | * 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 | * 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. | * 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> | * 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> | ||
* '''T1b''': Rather than | === '''T1 stage gallbladder cancer''' === | ||
'''T2 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> | ||
* '''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> | *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. | * 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> | === '''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. | * 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> | === '''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]]. | * 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. | *Types of surgical interventions are different and can range simple [[cholecystectomy]] to combined with partial [[hepatectomy]], with or without regional [[lymph node]] [[resection]]. | ||
==References== | ==References== | ||
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
- Complete surgical tumour resection is the only curative treatment but is mostly challenging because of the anatomical position of the gallbladder.
- Glenn and Hays was first proposed ''radical cholecystectomy'' in 1954 in which along with the gallbladder a small rim of the liver parenchyma and lymphatic tissue were excised [1]
- 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 were increased by incising the gallbladder or spilling its contents.
- Generally open procedure is recommended rather than laparoscopic procedure[2]
T1 stage gallbladder cancer
- T1a:Simple cholecystectomy alone is idle surgery of choice.[3][4]
- T1b:Rather than simple cholecystectomy a radical approach is more beneficial.
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
- In patients undergoing laparoscopic cholecystectomy incidental gallbladder cancer was found in 31 of 9497. [7]
- 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.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.