Gallbladder cancer, management of early tumors

In spite of the fatal course associated with patients with gallbladder cancer, there is a subgroup of them in whom prognosis could be improved. Although early gallbladder cancer is considered a tumor with invasion of the mucosa or the muscular layer, in this manuscript we analyze those with invasion confined to the gallbladder. Pre-operative diagnosis of these patients is rare with cholecystectomy specimen histologic analysis being the most common way of detecting these tumors. The level of wall invasion represents a useful and practical way of dividing the patients according to their prognosis and treatment. Mucosal and muscular invasion tumors could be cured by simple cholecystectomy. Among patients with a tumor confined to the gallbladder, those with subserosal infiltration represent the largest group. Residual tumor after cholecystectomy is a common fact in these patients, thus a more aggressive procedure than simple cholecystectomy should be performed. Generally, extended cholecystectomy is the preferred approach for dealing with these patients. Unfortunately, in spite of the employment of extended and potentially curative surgery, prognosis is still poor and additional therapeutic procedures are needed. Finally, when tumors compromise the serosal layer, 5-year survival is poor irrespective of the type of therapy. However, well-selected cases deserve to undergo aggressive treatment.