Surgical palliation of carcinoma of the gallbladder

Gallbladder cancer is the fifth most common gastrointestinal malignancy. Al though overall 5-year survival is less than five percent, improved survival has been reported in recent years for extended resection of localized lesi ons. Nonetheless, one-third of operations for gallbladder cancer are pallia tive procedures. There is no universally suitable palliative surgical proce dure and the choice of operation must take into account the general risk to the patient, the likely effect of surgery and the patient's principal symp toms of pain, jaundice and itch, nausea and/or vomiting. Cholecystectomy or drainage of the gallbladder may be necessary where obstr uction of the cystic duct results in complication. Gastrointestinal bypass may be required for patients with gastric outlet obstruction. Although bili ary bypass can be attempted to the extrahepatic biliary system or can be ac hieved by surgical intubation, there is increasing evidence that segment II I cholangiojejunostomy provides effective long-term decompression of the ob structed biliary tree. A sound multidisciplinary approach is required in the management of these p atients, the majority of whom are unlikely to survive beyond six months.