Surgical indications and extent of resection in gallbladder cancer

Gallbladder cancer often is diagnosed at an advanced stage when the prognosis is dismal. Early tumors (T1) that are recognized incidentally are curable with simple cholecystectomy alone. All other tumors should be resected with an extended cholecystectomy (T2) or with an extensive liver resection that obtains the negative margins. Patients with tumors greater than T1 should undergo lymphadenectomy that includes the porta hepatis and superior pancreatic nodes. Long-term survival with this approach is possible, even with T3 and T4 tumors. The role of extended lymphadenectomy, including the retropancreatic and aortocaval basins, is unclear and should be attempted only in selected cases.