How to treat gallbladder cancer effectively

In the past, gallbladder cancer was considered a rare malignant tumor that developed very quickly and had a very high mortality rate. But patients should not lose hope. Today's medical development is very fast, and medicine also attaches great importance to this disease. Believe that as long as you actively cooperate with the treatment now, one day medicine will develop very effective treatment methods, and there will be no problem in curing your disease. This disease has no obvious symptoms in the early stages, resulting in the late stage when it is discovered. Therefore, everyone should develop the habit of regular full-body examinations, make a clear diagnosis as soon as possible, and then use appropriate treatment methods, which will be very effective for the prognosis of gallbladder cancer. The following are the treatments for this disease.

(1) Radical surgery: Perform radical surgery according to the extent of the lesion and the biological characteristics of the tumor. Adson reported that 63% of the resected cases still did not meet the requirements of radical cure. If the lesion is still limited to the liver adjacent to the gallbladder and the lymph node metastasis does not exceed the second station, it should be considered as a curable gallbladder cancer and a reasonable radical surgery should be performed.

① Simple cholecystectomy: If the cancer is limited to the mucosal layer, simple cholecystectomy can achieve the purpose of radical cure without lymph node dissection. This situation is mostly due to benign lesions of the gallbladder, which are discovered during intraoperative or postoperative pathological examination. Some people believe that simple cholecystectomy can be performed for Nevin classification stage I and II, especially papillary carcinoma. Berhdam reported that if gallbladder cancer invades the mucosa and submucosal layer, simple cholecystectomy is required, and the 5-year survival rate after surgery can reach 64%, and the 10-year survival rate can reach 44%.

② Patients with regional lymph node dissection that invade the muscular layer and the entire layer of the gallbladder often have highly malignant pathological types of gallbladder lymph node metastasis, such as mucinous adenocarcinoma and undifferentiated carcinoma, and also need lymph node dissection. The scope of dissection includes the first and second station lymph nodes, with the right edge of the portal vein as the boundary, and the lymph nodes in the hepatoduodenal ligament are completely removed. Then the duodenum is turned up to remove the pancreaticoduodenal and lower common bile duct lymph nodes.

③ Liver wedge resection: If the lesion invades the entire layer of the gallbladder or the adjacent liver, a liver wedge resection should be performed. A 1.5-4 cm liver wedge resection should be performed along the edge of the gallbladder bed according to the extent of the lesion.

④Right hepatic lobectomy and hepatic segment resection: used for patients with a large range of liver bed infiltration and direct infiltration of the hepatic duct. 50 years ago, some people began to use right hemihepatectomy to treat gallbladder cancer. More than 20 cases were reported in the literature, and only one case survived for 5 years, indicating that this operation cannot improve the survival rate. Bismuth used liver segment resection to treat 5 cases of Nevin stage IV. Except for one case with residual cancer who recurred and died 2 years after surgery, the other 4 cases are still alive, and 3 have survived for more than 2 years. The surgical mortality rate is also low, and the long-term efficacy is good. Therefore, for cases with metastasis to the adjacent liver, especially gallbladder ampulla cancer, liver segment resection Ⅳ and Ⅴ is a more reasonable extended surgical method.

⑤ Partial resection of other adjacent organs: If the gastric antrum, duodenum, or hepatic flexure of the colon are invaded, the affected organs and the gallbladder can be removed as a whole.

⑥ Partial resection of the extrahepatic bile duct: For lesions located in the neck of the gallbladder or extending to the cystic duct, as well as papillary carcinoma, special attention should be paid to exploring the extrahepatic bile duct. If the bile duct is found to be invaded, it should be removed at the same time.

Gallbladder cancer discovered during or after cholecystostomy should be radically resected as soon as possible if necessary, and the resection should include the tissues around the abdominal sinus. When there is a gastrointestinal fistula, the adjacent organs should be removed at the same time; acute perforated gallbladder cancer should be flushed with distilled water and anticancer drugs at the end of the operation.