Gallbladder carcinoma and surgical treatment

Gallbladder carcinoma shows an unusual geographic and demographic distribut ion. It is relatively uncommon in Europe, but more frequent in Israel, Chil e, Bolivia and in Southwestern Native Americans in the United States. Chron ic cholecystitis, choledochal cysts, high body mass index, female gender, a ge, nicotine and industrial exposure to carcinogens are associated risk fac tors. The frequency of gallbladder cancer in all operations of the biliary tract is about 1-3%, reflecting the commonest biliary tract malignancy. Pre operative imaging, including ultrasound and computed tomography (CT), may r eveal signs indicative of the presence of malignancy. However, most patient s are not diagnosed prior to surgical intervention. Survival, depends on th e ability to achieve a curative resection, including hepatectomy and lymph node dissection in patients with local extended tumour according to the sta ge of the disease. Overall, the curative resection rates for gallbladder ca rcinoma range from 10% to 30%. Regional and paraaortic lymphadenectomy prov ides no survival benefit for patients with para-aortic disease, which has a negative influence on prognosis equivalent to that of distant metastases. A survival benefit is seen only in selected patients with metastases limite d to the regional nodes. Taking a sample biopsy of the para-aortic nodes be fore starting surgery is recommended because these nodes are involved more frequently than expected. For those patients with unresectable cancer, pall iative surgical, endoscopic or radiological bypass procedures can improve q uality of life. Other approaches to the management of advanced tumours incl ude systemic chemotherapy or combined chemo-radiotherapy and need further e valuation. Early-stage tumours are often discovered as an incidental findin g during (laparoscopic) cholecystectomy or on histological examination of t he gallbladder, mostly necessitating relaparotomy and extensive resection. In the following, management of patients with gallbladder cancer at differe nt stages and situations is discussed.