The Update of Diagnosis and Surgical Treatment for Gallbladder Cancer

Abstract

There are various pathological conditions in gallbladder cancer. We aim on the matters that are to be discussed, such as diagnosis and surgical procedure, based on the progression stage and site.

1. Computed tomography has been reported to have a sensitivity and specificity of 33% and 94%, respectively, for early-stage gallbladder cancer ; therefore, it should be noted that the sensitivity is low.

2. Endoscopic ultrasound has excellent diagnostic ability for polypoid lesions with a sensitivity and specificity of 91.7% and 87.7%, respectively ; however, the diagnostic accuracy for invasion depth is 55.5%.

3. In stage T1a diagnosed postcholecystectomy, additional resection is not required as well as in stage T1b, if the diagnosis was based on total cholecystectomy specimens.

4. The standard surgical procedure in T2 cases is gallbladder bed resection plus field lymphadenectomy. In the seventh edition of the Classification of Biliary Tract Cancer, T2 with lesions on the peritoneal side are classified as T2a (SS), while lesions on hepatic side are classified as T2b (SS). T2a has a good prognosis.

5. Surgically, in patients with a tumor invasion depth of T3 or higher, it is essential to consider the balance between safety and prognosis. Diagnosis based on the mode of cancer spread is important. Although R0 resection is technically possible, caution should be observed in the indications for surgery of cancer with hepatic hilar invasion and another organ invasion.