There are 2 general types of surgical treatment for cancer of the gallbladder -- potentially curative surgery and palliative surgery.

Potentially curative surgery is done when imaging tests indicate a there is good chance that the surgeon will be able to remove all of the cancer. Doctors may use the term resectable to describe cancers they believe can be removed by potentially curative surgery and unresectable to describe those they think have spread too far or are in too difficult a place to be entirely removed by surgery. Unfortunately, only a small portion of gallbladder cancers are resectable when they are first found.

Palliative surgery may be done to relieve pain or prevent complications, such as blockage of the bile ducts, if the tumor is too widespread to be completely removed. Palliative surgery is not expected to cure the cancer, but it can sometimes help relieve symptoms and/or prolong a person's life. Palliative surgery is described in more detail in the section "Palliative therapy."

Surgery to remove gallbladder cancer can have significant side effects and, depending on how extensive it is, may require several weeks for recovery. Patients whose cancer is not curable may want to carefully weigh the pros and cons of surgery or treatments that require significant recovery time. Unless there is clear evidence that such treatments will improve the patient's chance for longer survival or improved quality of life, some patients with very advanced stages of gallbladder cancer may choose to avoid them.

Cholecystectomy (simple cholecystectomy)

The operation to remove the gallbladder is called a cholecystectomy. If the entire gallbladder (but only the gallbladder) is removed, the operation may be called simple cholecystectomy.

Most doctors use this operation to treat gallbladder cancer only if there is a very good chance that the cancer is at a very early stage (T1a) and is unlikely to have spread outside of the gallbladder. It's not possible for doctors to know the true extent of the disease until after surgery, when the gallbladder is looked at under a microscope. If at this point the cancer is still found to be at an early stage, no further surgery may be needed. But if the cancer is found to be more advanced than was believed, a second, more extensive surgery is typically recommended.

Gallbladder cancers are sometimes found incidentally (by accident) after a person has a cholecystectomy for another reason, such as gallstones. Again, if the doctor feels it's likely that the cancer has been completely removed, 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 may be done in 2 ways:

Laparoscopic cholecystectomy: This is the most common way to remove a gallbladder for benign problems. This method uses a laparoscope, a thin, flexible tube with a tiny video camera on the end that is inserted through a small surgical opening in the patient's abdomen. Surgical instruments are placed through several other small openings to remove the gallbladder.

Laparoscopic surgery tends to be easier for patients because of the smaller incision size. But because laparoscopic cholecystectomy has sometimes led to the accidental spread of the cancer to other parts the body, it is usually not done if gallbladder cancer is suspected.

If gallbladder cancer is found during a laparoscopic cholecystectomy, the surgeon will switch to an open cholecystectomy (making a larger incision and using standard surgery tools for the rest of the operation). The change is made to avoid the risk of leaving behind cancer that may have spread outside the gallbladder. It may also avoid "seeding" the abdominal cavity with cancer cells that might be squeezed out of the gallbladder as it is removed. Laparoscopic cholecystectomy is not a cancer operation because most people treated this way have cancer left behind that will need to be removed in another, more extended, operation.

Open cholecystectomy: In this approach, the surgeon removes the gallbladder through a large incision (cut) in the abdominal wall. This method is used for some operations for gallstones, and a type of open cholecystectomy often is used if gallbladder cancer is suspected.

Extended (radical) cholecystectomy

Because of the risk that the cancer will come back if just the gallbladder is removed, a more extensive operation, known as an extended (or radical) cholecystectomy, is done in most cases of gallbladder cancer. This can be an involved, complex operation, and it is best done by a surgeon experienced in treating gallbladder cancer.

The extent of the surgery depends on where the cancer is located 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

If the surgeon feels it is needed and the patient is healthy enough, the operation may also include one or more of the following:

• removing more 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)

• removing the common bile duct

• removing part or all of the ligament that runs between the liver and the intestines

• removing lymph nodes around the pancreas, around the major blood vessels leading to the liver (the portal vein and hepatic artery), and around the artery that brings blood to most of the small intestine and to the pancreas (removing lymph nodes is called a lymphadenectomy or lymph node dissection)

• removing the pancreas

• removing the duodenum (the first part of the small intestine into which the bile duct drains)

• removing any other areas of organs to which cancer has spread

Often, when gallbladder cancer is suspected, the surgeon will do a laparoscopy before any other surgery. In this procedure, a small cut is made so that a long, lighted tube called a laparoscope can be inserted into the abdomen. The doctor uses the laparoscope to look around the abdominal cavity for signs of cancer spread. This helps in planning the operation to remove the cancer.

Possible risks and side effects

The risks and side effects of surgery depend in large part on how much tissue is removed and a person's general health before the surgery. All surgery carries some risk, including the possibility of bleeding, 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, although this can usually be controlled with medicines if needed. The incision is larger for an open cholecystectomy, so there is usually more pain and a longer recovery time.

Extended cholecystectomy is a major operation that may involve removing parts of several organs. This can have a significant effect on a person's recovery and health after the surgery. Because most of the organs are involved in digestion, eating problems may be a concern for some time after surgery.

For more general information about surgery, please see our document, Surgery.

Last Medical Review: 11/02/2009
Last Revised: 11/02/2009