A brief discussion on the principles of surgical treatment of gallbladder cancer

Gallbladder cancer has become one of the malignant tumors in the world. The radical surgery principle for occult gallbladder cancer refers to patients who have not been diagnosed before or during surgery, but are diagnosed as gallbladder cancer by pathological sections 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 finds that the cancer has only invaded the mucosal layer or the muscular layer, a simple complete cholecystectomy is sufficient to achieve the purpose of radical cure, and a second radical operation 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 bottom cancer group. Therefore, occult gallbladder cancer located in the gallbladder neck and gallbladder duct, regardless of which layer of the gallbladder wall it invades, should undergo another lymph node dissection around the hepatoduodenal ligament. For occult gallbladder cancer with an infiltration depth exceeding the muscular layer, positive resection margins, and positive gallbladder triangle lymph node biopsy, a second radical operation should also be performed.

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 number of case analyses, only about 23% of gallbladder cancer can be radically removed. Overall, the median survival 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 been significantly improved. 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 of the metastatic lymph node is cleared. Early gallbladder cancer only needs to remove the gallbladder lymph nodes, but most resectable gallbladder cancers should clear the lymph nodes of the hepatoduodenal ligament, and if necessary, the superior pancreaticoduodenal and posterior pancreatic lymph nodes should also be cleared.

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, bile duct internal 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 those who are unable to undergo the above surgery due to severe hilar invasion, the right liver can be cut open by scraping and suction to find the dilated hepatic duct in the right liver for catheter drainage.

After reading the above principles of surgical treatment for gallbladder cancer, do you have any experience? For patients in the advanced stage, we should remain optimistic. Late-stage surgery is to relieve pain and improve the quality of life. If you still have questions, please consult Feihua Health Network, and the experts will answer them for you. I wish you good health and all the best!

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