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, potentially curative surgery might be done.
• If the cancer is unresectable, meaning the cancer is too far advanced, has spread too far, or is in a location that makes it too difficult to remove entirely with surgery, palliative surgery might be done to help relieve or prevent symptoms.

 

Determining which type of gallbladder cancer 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 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. Gallbladder cancer surgery 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, such as pain, or to treat (or even prevent) complications, such as blockage of the bile ducts or bleeding. 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 often is used before other surgery 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 removable, laparoscopy can also help plan the operation.

Surgery to remove gallbladder cancer can have serious side effects and, depending on how extensive it is, recovery might take many weeks. 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 gallbladder cancers

Simple cholecystectomy

The surgery 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.

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 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 accidentally spread cancer cells 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 it is important to go to a surgeon who is experienced in this procedure.

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 least 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 gallbladder cancers

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

Possible risks and side effects of gallbladder cancer surgery

The risks and side effects of surgery depend on how much tissue is removed and a person's overall health before the surgery. All surgery carries some risk, including the possibility of:

• Bleeding
• Blood clots
• Infections
• Complications from anesthesia
• 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 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.