Surgery for Gallbladder Cancer

There are 2 general approaches to surgery for gallbladder cancer:

• If the cancer is resectable, meaning the doctor believes it can be removed completely, then potentially curative surgery might be done.
• If the cancer is unresctable, meaning the cancer is too far advanced, has spread too far, or is in too difficult a place to be entirely removed by surgery, then palliative surgery might be done to help relieve or prevent symptoms.

Determining which type of surgery is needed

Potentially curative surgery is done when imaging tests or the results of earlier surgeries show there is a good chance that the surgeon can remove all of the cancer. Only a small percentage of gallbladder cancers are resectable when they are first found.

If potentially curative surgery is being considered, you may want to get a second opinion or even be referred to a large cancer center. Nearly all doctors agree that surgery offers the only realistic chance for curing people with gallbladder cancer. But there are differences of opinion about how advanced a gallbladder cancer can be and still be treatable with surgery. The surgery needed for gallbladder cancer is often complex and requires an experienced surgeon. These operations are most often done at major cancer centers.

Palliative surgery is done to relieve symptoms pain or treat (or even prevent) complications, such as blockage of the bile ducts. This type of surgery is done when the cancer is too widespread to be removed completely. Palliative surgery is not expected to cure the cancer, but it can sometimes help a person feel better and can help them live longer. Learn more in Palliative Therapy for Gallbladder Cancer.

Laparoscopy to plan for gallbladder cancer surgery

Often, when gallbladder cancer is suspected, the surgeon will do a laparoscopy before any other surgery. This is done to help look for any spread of the cancer that could make curative surgery not an option. This procedure is described in Tests for Gallbladder Cancer. During the laparoscopy, the surgeon can look for areas of cancer that did not show up on imaging tests. If the cancer is resectable, laparoscopy can also help plan the operation to remove it.

Surgery to remove gallbladder cancer can have serious side effects and, depending on how extensive it is, you may need many weeks for recovery. If your cancer is very unlikely to be curable, be sure to carefully weigh the pros and cons of surgery or other treatments that will need a lot of recovery time.

It’s very important to understand the goal of any surgery for gallbladder cancer, what the possible benefits and risks are, and how the surgery is likely to affect your quality of life.

Surgery for resectable cancers

Simple cholecystectomy

The operation to remove the gallbladder is called a cholecystectomy. If only the gallbladder is removed, it's called a simple cholecystectomy. This operation is often done to remove the gallbladder for other reasons such as gallstones, but it's not done if gallbladder cancer is known or suspected (a more extensive operation is needed done instead).

Gallbladder cancers are sometimes found by accident after a person has a cholecystectomy for another reason. If the cancer is at a very early stage (T1a) and is thought to have been removed completely, no further surgery may be needed. If there’s a chance the cancer may have spread beyond the gallbladder, more extensive surgery may be advised.

A simple cholecystectomy can be done in 2 ways:

Laparoscopic cholecystectomy: This is the most common way to remove a gallbladder that's not known to have cancer. The surgeon puts a laparoscope , a thin, flexible tube with a tiny video camera on the end, into the body through a small cut in the skin of the abdomen (belly). Surgical tools are put in through other small openings to remove the gallbladder.

Laparoscopic surgery tends to be easier for patients because of the smaller incision size. But this type of operation isn't used if gallbladder cancer is suspected. This surgery gives the surgeon only a limited view of the area around the gallbladder, so there's a greater chance that some cancer might be missed and left behind. Removing the gallbladder this way might also lead to the accidental spread of the cancer as the gallbladder is taken out.

Open cholecystectomy: The surgeon takes out the gallbladder through a large incision (cut) in the abdominal wall. This method is sometimes used for gallbladder problems that aren't cancer (such as gallstones), and may lead to the discovery of gallbladder cancer. But if gallbladder cancer is suspected before surgery, doctors prefer to do an extended cholecystectomy.

Extended (radical) cholecystectomy

Because of the risk that the cancer will come back if just the gallbladder is removed, a more extensive operation, called an extended (or radical) cholecystectomy, is done in most cases of gallbladder cancer. This can be a complex operation, so make sure your surgeon is experienced with it.

The extent of the surgery depends on where the cancer is and how far it might have spread. At a minimum, an extended cholecystectomy removes:

• The gallbladder
• About an inch or more of liver tissue next to the gallbladder
• All of the lymph nodes in the region (at minimum, 6 lymph nodes need to be removed to properly stage the cancer)

If your surgeon feels it's needed and you are healthy enough, the operation might also include removing one or more of the following:

• A larger part of the liver, ranging from a wedge-shaped section of the liver close to the gallbladder (wedge resection) to a whole lobe of the liver (hepatic lobectomy)
• The common bile duct
• Part or all of the ligament that runs between the liver and the intestines
• Lymph nodes around the pancreas and, around the major nearby blood vessels
• The pancreas
• The duodenum (the first part of the small intestine into which the bile duct drains)
• Any other areas or organs to which cancer has spread

Palliative surgery for unresectable cancers

Surgery is less likely to be done for unresectable cancers, but there are some instances where it might be helpful, this is called palliative surgery. The goal is not to treat the cancer, but to treat the problems it causes. An example is putting a plastic or expandable metal tube (called a stent) inside bile duct that's blocked by the tumor. This can keep the duct open and allow bile to flow through it.

You can find more details on palliative procedures at Palliative Therapy for Gallbladder Cancer.

Possible risks and side effects of surgery

The risks and side effects of surgery depend on how much tissue is removed and your overall general health before the surgery. All surgery carries some risk, including the possibility of bleeding, blood clots, infections, complications from anesthesia, and pneumonia.

Laparoscopic cholecystectomy is the least invasive operation and tends to have fewer side effects. Most people will have at least some pain from the incisions for a few days after the operation, but this can usually be controlled with medicines. A bigger incision is needed for an open cholecystectomy, so there is usually more pain and a longer recovery time.

Extended cholecystectomy is a major operation that might mean removing parts of several organs. This can have a major significant effect on a person’s recovery and health after the surgery. Serious problems soon after surgery can include bile leakage into the abdomen, infections, and liver failure. Because most of the organs removed are involved in digestion, eating and nutrition problems may be a concern after surgery. Your doctor or nurse will discuss the possible side effects with you in more detail before your surgery.