What to do if gallbladder cancer metastasizes to the liver in the advanced stage

Generally, the site of liver metastasis of gallbladder cancer is mainly along the portal vein trunk, located in the loose connective tissue between the gallbladder and the liver. About 45-77% of patients are found to have hilar lymph node metastasis during surgery or autopsy, with a lymph node metastasis rate of 86% and a hilar lymph node metastasis rate of 62%. Among them, about 2-20 small veins finally pass through the gallbladder fossa and end in the liver parenchyma at the liver bed, or merge into 1-2 branches and enter the liver, ending in the hepatic vein or the portal vein trunk of segments V and VIII.

How to treat symptoms of advanced liver metastasis of gallbladder cancer

1. Liver resection surgery:

Clinically, comprehensive systemic treatment is recommended for the treatment of gallbladder cancer metastasis. For some cases, it can be removed at the same time as the primary lesion of gallbladder cancer. If the patient is in good physical condition and can tolerate surgery, palliative resection can be performed first; for patients with large lesions and distant metastases who are not suitable for radical surgery, in order to relieve ulcer bleeding or pain, debulking surgery or palliative resection can be considered as long as the anatomical conditions permit.

Selective cholecystectomy plus appropriate liver resection plus lymph node clearance, if the extrahepatic bile duct is invaded, additional extrahepatic bile duct resection or pancreaticoduodenectomy can achieve a more satisfactory therapeutic effect. The main methods of intraoperative liver resection are liver bed resection, liver segment resection and liver lobectomy, including the right half of the liver or the right three lobes. The reasonable range of resection mainly depends on the judgment of the margin. Blindly expanding the resection will not improve the survival rate, but may increase the perioperative mortality and complications. Therefore, the key to improving the efficacy is the absence of residual cancer cells at the liver resection margin after surgery and thorough lymph node clearance.

2. Radiotherapy and chemotherapy assisted surgical treatment:

Since gallbladder cancer is insensitive to chemotherapy drugs, radiotherapy and chemotherapy are generally not recommended for gallbladder cancer treatment. However, radiotherapy and chemotherapy can be used as adjuvant therapy after surgery. In addition, multiple metastatic nodules in distant parts cannot be surgically removed, and hepatic artery catheterization chemotherapy, i.e. interventional chemotherapy, can be used. Combined with some Chinese medicines such as ginsenoside Rh2 for auxiliary treatment, it can enhance efficacy and reduce toxicity, while improving immunity.

3. Combined treatment with TCM ginsenoside Rh2:

It should be noted that surgical resection should be used with caution in late-stage treatment. For patients with advanced gallbladder cancer who are suitable for surgical treatment, they can be assisted with traditional Chinese medicine treatment after surgery to restore the patient's physical condition to a certain extent by strengthening the body, eliminating evil, replenishing qi, nourishing blood, and harmonizing the spleen and stomach. For patients with liver metastasis of gallbladder cancer who have weak physical functions and cannot tolerate surgery, combined radiotherapy and chemotherapy with traditional Chinese medicine treatment are often used clinically. The combined treatment of traditional Chinese medicine such as ginsenoside Rh2 has the effect of enhancing efficacy and reducing toxicity. It can reduce some side effects of chemotherapy, directly inhibit the proliferation of cancer cells, induce apoptosis and differentiation, and will not produce drug resistance. It can be taken for a long time and improve the quality of life of patients.