Does pregnancy affect the treatment of gallbladder cancer?

Gallbladder cancer is one of the common malignant tumors in the biliary system. Among the malignant tumors of the gallbladder, gallbladder cancer ranks first. Others include sarcoma, carcinoid, primary malignant melanoma, giant cell adenocarcinoma, etc. Since the latter are rare, this chapter mainly discusses primary gallbladder cancer. Women are 2 to 4 times more likely to develop the disease than men. It is more common in people aged 50 to 70 years.

1. Principles of surgical treatment of gallbladder cancer

(1) Principles of radical surgery for occult gallbladder cancer. Occult gallbladder cancer refers to cancer that has not been diagnosed before or during surgery, but is diagnosed as gallbladder cancer by pathological section after cholecystectomy for "benign" diseases. Since the diagnosis is made after surgery, the question is whether radical surgery is needed again. If the postoperative pathological section shows that the cancer has only invaded the mucosal layer or muscular layer, a complete cholecystectomy alone is sufficient to achieve the radical cure, and a second radical surgery is not necessary. The lymphatic metastasis of gallbladder cancer first affects the gallbladder triangle and the lymph nodes distributed along the common bile duct. Cancer located in the gallbladder neck, especially the gallbladder duct, occurs earlier because of its proximity to the gallbladder triangle. The postoperative recurrence rate of gallbladder neck cancer is also significantly higher than that of the gallbladder body base cancer group. Therefore, occult gallbladder cancer located in the gallbladder neck and cystic duct should undergo lymph node dissection around the hepatoduodenal ligament again, regardless of which layer of the gallbladder wall it invades. For occult gallbladder cancer with invasion depth exceeding the muscle layer, positive resection margin and positive gallbladder triangle lymph node biopsy, a second radical surgery should also be performed.

(2) Radical surgery for gallbladder cancer: Since gallbladder cancer patients are often not in the early stage when they seek medical treatment, according to a large case analysis, only about 23% of gallbladder cancer patients can be radically removed. Overall, the median survival time of gallbladder cancer patients is 3 months. Therefore, some surgeons are pessimistic about the treatment of gallbladder cancer. In recent years, due to the development of radical surgery for gallbladder cancer, the 5-year survival rate after surgery has increased significantly. The scope of radical surgery mainly includes cholecystectomy, partial liver resection and lymph node dissection. The liver is generally removed about 3 cm around the gallbladder bed. Lymph node dissection depends on its confluence pathway and metastasis. Generally, the next stop lymph node is dissected. Early gallbladder cancer only needs to remove the gallbladder lymph nodes, but most resectable gallbladder cancers should have the lymph nodes of the hepatoduodenal ligament cleared, and if necessary, the superior pancreaticoduodenal and posterior pancreatic lymph nodes should also be cleared.

(3) Palliative surgery for advanced gallbladder cancer: For cases of advanced gallbladder cancer that cannot be cured, the principle of surgery is to relieve pain and improve the quality of life. The most prominent problem of advanced gallbladder cancer is obstructive jaundice caused by cancer invasion of the biliary system. Internal drainage should be considered as much as possible during surgery. Internal drainage methods include bile duct jejunostomy, but because local cancer infiltration is often deep, especially with hilar infiltration, internal bile duct drainage is often difficult to perform. For such patients, bridging internal drainage can be performed. For cases with extremely poor systemic conditions, catheter external drainage can also be performed. For patients with severe hilar invasion who cannot undergo the above surgery, the right liver can be cut open by scraping and suction to find the dilated hepatic duct in the right liver for catheter drainage.

2. Radiotherapy: It is only used as an auxiliary method after surgery or in cases where resection is impossible. Todoroki reported that the 3-year survival rate of gallbladder cancer lesion resection plus radiotherapy was 10.1, while that of patients without radiotherapy was 0. The general radiation dose is 40 to 50 GY. Intraoperative radiation is to use an electron beam generated by a cyclotron to give a radiation dose of 20 to 30 GY after the lesion is removed.

3. Chemotherapy: Gallbladder cancer is insensitive to various chemotherapy drugs, and it is difficult to observe its efficacy. It is mostly used for postoperative adjuvant therapy. Commonly used drugs include ADM, 5-FU, MMC, etc. (VI) Prognosis The 5-year survival rate of gallbladder cancer is very low, about 2% to 5%; more than 80% of patients may die within 1 year. If gallbladder cancer only invades the mucosa and submucosal layer, the prognosis of cholecystectomy is better. Some people report that the 5-year survival rate of this group of patients can reach 40% to 64%. Therefore, the key to the prognosis lies in early diagnosis and timely treatment.