[Current surgical treatment for gallbladder cancer]

Surgical resection offers the best chance for cure in patients with gallbladder cancer. An aggressive surgical approach to gallbladder cancer has been advocated to minimize morbidity and improve long-term survival. The theoretical mechanism of hepatic spread from gallbladder cancer includes direct extension, hematogenous metastasis, and lymphatic spread. Direct liver invasion and portal tract invasion are the main modes of hepatic spread from resectable gallbladder cancer. Portal tract invasion mainly results from lymphatic spread within the portal tracts. Partial hepatectomy involving the gallbladder bed is a critical part of gallbladder cancer resection and is a safe procedure. The performance of major hepatectomy is justified only if potentially curative resection is feasible. The presence of peripancreatic nodal disease is not a contraindication for radical resection. Combined major hepatectomy and pancreaticoduodenectomy provide survival benefit for some patients with locally advanced gallbladder cancer. Patients with gallbladder cancer with no bile duct involvement are potential candidates for this aggressive procedure, but the mortality rate after this procedure is higher. Patients with advanced gallbladder cancer should be managed at high-volume centers. The combination of surgery with chemotherapy should be established in the management of patients with locally advanced gallbladder cancer.