Surgical Management of Locally Advanced and Metastatic Gallbladder Cancer

Advances in systemic therapy for gastrointestinal malignancies have opened the door for surgical resection of tumors previously deemed unresectable. Of these tumors, gallbladder cancer has a particularly poor prognosis due to the aggressive nature of the disease. The preferred systemic therapy regimen for gallbladder cancer has progressed from single-agent chemotherapy to multi-agent therapy including immune checkpoint inhibitors, with additional targeted therapies currently under investigation. These advancements have provided patients with historically unresectable tumors with a bridge to surgical resection and a hope of extended survival or cure. Surgical options for locally advanced tumors have expanded, and experienced centers perform a variety of operations to achieve resection with negative margins, including extended liver resection, bile duct resection, vascular reconstruction, and adjacent organ resection. There is also growing evidence that patients with Stage IV disease may benefit from resection of their primary tumors and metastases. This review outlines the current treatment practices for patients with locally invasive and metastatic gallbladder cancer as well as emerging treatment options.