Changing Perspectives in Managing Metastatic Gallbladder Cancer: Defining Oligometastatic Disease, Current...

Oligometastasisdisease (OMD) is an intermediate stage between localised disease and widespread metastasis. No standard OMD definition exists for gallbladder cancer (GBC). This review examines OMD definitions in GBC, treatment challenges, current strategies like systemic therapy, immunotherapy, surgery, loco-regional therapy, emerging approaches, and future directions for GBC patients with OMD.

A literature review of GBC and oligometastasiswas conducted using PubMed and Google Scholar through July 2025.

Metastatic GBC has a poor prognosis; however, a combination of systemic and immunotherapy can slightly improve survival, ranging from 11.3 to 12.7 months. OMD is a subgroup of patients (with 1-3 liver metastases, para-aortic lymph nodes, metastasis limited to adherent omentum, and/or up to three peritoneal deposits) who experience better survival with consolidative treatment, including neoadjuvant therapy followed by curative resection (such as minor hepatectomy, para-aortic lymphadenectomy) and adjuvant therapy. Reported survival rates at 1, 3, and 5 years range from 20 to 64.0%, 5.7-17%, and 0-23%. Risk factors like extensive hepatic lobectomy and portal vein resection in cholestatic liver increase morbidity and mortality. Elevated preoperative tumour markers (CEA, CA 19 - 9) are associated with poorer survival.

There is no standard definition of OMD in GBC. Our review emphasises the need to develop a standardised definition of OMD in GBC and for multidisciplinary evaluation and well-designed clinical trials to expand therapeutic options and to optimise patient outcomes.