Surgery for Gallbladder Cancer
There are 2 general types of surgery for cancer of the gallbladder:
- Potentially curative surgery
- Palliative surgery
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. Doctors use the term resectable to describe cancers they believe can be removed completely by surgery and unresectable to describe those that have spread too far or are in too difficult a place to be removed by surgery. Unfortunately, only a small portion 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 pain or prevent complications, such as blockage of the bile ducts, if the tumor is too widespread to be removed completely. 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 “ Palliative therapy for gallbladder cancer.”
Gallbladder cancer surgery can have serious side effects and, depending on how extensive it is, may require several weeks for recovery. Patients whose cancer is very unlikely to be curable need to carefully weigh the pros and cons of surgery or treatments that require 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.
Often, when gallbladder cancer is suspected, the surgeon will do a laparoscopy before any other surgery. This is done to help determine how far the cancer has spread and if it can be resected or not. Laparoscopy may let the surgeon see areas of cancer that were not detected with imaging tests.
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 inside the abdomen for signs of cancer spread. If the cancer is resectable, laparoscopy can also help plan the operation to remove it.
Cholecystectomy (simple cholecystectomy)
The operation to remove the gallbladder is called a cholecystectomy. If only the gallbladder is removed, the operation may be called simple cholecystectomy.
This operation is often used to remove the gallbladder for other reasons such as gallstones, but it is not done if gallbladder cancer is known or suspected (a more extensive operation is done instead).
Gallbladder cancers are sometimes found by accident after a person has a cholecystectomy for another reason, such as gallstones. 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 for non-cancerous problems, such as gallstones. The surgeon uses a laparoscope, a thin, flexible tube with a tiny video camera on the end that is inserted through a small cut in the skin of the abdomen. Long surgical tools are placed 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 is not used if gallbladder cancer is suspected. This surgery offers the surgeon only a limited view of the area around the gallbladder, so there is a greater chance that some cancer might be missed and left behind. It might also lead to the accidental spread of the cancer to other parts the body.
Open cholecystectomy: In this approach, the surgeon removes the gallbladder through a large incision (cut) in the abdominal wall. This method is sometimes used if a non-cancerous gallbladder problem is suspected (such as gallstones), which in some cases 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, known as 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 in treating gallbladder cancer.
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
If your surgeon feels it is needed and you are healthy enough, the operation may 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, 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
- 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
Possible risks and side effects
The risks and side effects of surgery depend on how much tissue is removed and your 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, although this can usually be controlled with medicines. 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 remove parts of several organs. This can have a 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 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.
For more general information about cancer surgery, see A Guide to Cancer Surgery.
Last Medical Review: October 29, 2014 Last Revised: February 5, 2016