Consideration of anatomical structures relevant to the surgical strategy for managing gallbladder carcinoma
Charles H C Pilgrim1, Val Usatoff, Peter Evans
1The Alfred Hospital, Upper Gastrointestinal Surgery, Commercial Rd, Melbourne, VIC 3000, Australia. charlespilgrim@hotmail.com
Aims:
Gallbladder carcinoma usually presents late with advanced disease. It develops in an anatomically complex area. Consideration is given to resection of relevant local structures with respect to outcome.
Methods:
A comprehensive literature review was performed, searching Medline for articles published since 2000, using the MeSH heading of 'gallbladder cancer' and 'surgery'. Abstracts were reviewed and articles retrieved if the main focus of the article centred on the surgical management of gallbladder carcinoma.
Observations:
Hepatic resection is advocated and tailored to pathological T stage. Lymph node dissection and bile duct resection, as well as en bloc resection of other viscera, remain areas of controversy.
Conclusions:
Eastern and Western practice standards of care differ, but hepatic resection with some lymph node dissection is present in both approaches. Philosophy regarding aggression with respect to en bloc resection of adjacent organs and actual extent of lymphatic resection remains disparate.
