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There are 2 general types of surgery for gallbladder cancer: potentially curative surgery (resectable and unresectable) and palliative surgery.
Potentially curative surgery (or resectable) 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 can be removed.
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 tumor 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. More detail is described in Palliative Therapy for Gallbladder Cancer.
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.
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 for anon-cancerous problem that's not 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). Long surgical tools are put in through other small openings to take out 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.
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:
If your surgeon feels it's needed and you are healthy enough, the operation may also include removing one or more of the following:
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.
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.
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Abou-Alfa GK, Jarnagin W, Lowery M, D’Angelica M, Brown K, Ludwig E, Covey A, Kemeny N, Goodman KA, Shia J, O’Reilly EM. Liver and bile duct cancer. In: Neiderhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, PA. Elsevier; 2014:1373-1395.
Castro C-M, Santibañez SP, Rivas TC, Cassis NJ. Totally Laparoscopic Radical Resection of Gallbladder Cancer: Technical Aspects and Long-Term Results. World J Surg. 2018 Mar [Epub ahead of print].
National Cancer Institute. Gallbladder Cancer Treatment (PDQ®)–Patient Version. March 22, 2018. Accessed at www.cancer.gov/types/gallbladder/patient/gallbladder-treatment-pdq on June 22, 2018.
National Comprehensive Cancer Network, Clinical Practice Guidelines in Oncology (NCCN Guidelines®), Hepatobiliary Cancers, Version 2.2018 -- June 7, 2018. Accessed at www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf on June 22, 2018.
Patel T, Borad MJ. Carcinoma of the biliary tree. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2015:715-735.
Zaidi MY, Maithel SK. Updates on Gallbladder Cancer Management. Curr Oncol Rep. 2018;20(21):1-7.
Last Revised: July 12, 2018
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