Gallbladder Cancer: Diagnosis and Surgical Management

Abstract

Gallbladder cancer (GBCa) is a biliary tract malignancy that is common in South America and Southeast Asia, where patients often present with abdominal pain and jaundice. However, most cases of GBCa in the United States are diagnosed incidentally following cholecystectomy. The pre-operative diagnosis and evaluation involves imaging with ultrasound, CT, MRI, and PET. In patients with incidental GBCa, the histopathology directs further management. The surgical management of GBCa ranges from a simple cholecystectomy to liver resection with lymphadenectomy. Bile duct and vascular resections are reserved to obtain negative margins. To date, multiple controversies remain in the management of GBCa. The determination of type of surgery is based predominantly on T stage. The need for liver resection for tumor on the peritonealized surface continues to be debated. The added value of neoadjuvant and peri-operative therapy is being actively investigated. Systemic therapy has greatly evolved encompassing the use of capecitabine, gemcitabine-cisplatin, with recent addition of taxanes, HER2 inhibitors, and immunotherapy using PD-L1 inhibitors including Durvalumab. This chapter describes current diagnosis and treatment practices for GBCa especially determinants of surgical management and the benefits of peri-operative systemic therapy highlighting the recent advances and shortcomings.