Gall Bladder Cancer Surgery

Gall bladder cancer is the 5th most common digestive cancer. In India, its found in higher frequency in Northern India. Sometimes cancer in the gall bladder is accidentally detected on gall bladders removed for gall stone disease (incidental gall bladder cancer). Removal of the gall bladder is a very common operation. Rarely there can be cancer discovered on pathological examination of the gall bladder. These patients will then need a definitive treatment and further surgery for complete removal of cancer.

Risk Factors For Gall Bladder Cancer

• Chronic inflammation of the gall bladder - chronic cholecystitis
• Gall bladder polyps > 1 cm in size - gall bladder polyps are usually small growths that arise from the gall bladder. Most polyps are benign - and do not run the risk of cancer. However the risk of cancer developing in a polyp is dependant on its size. Polyps > 1 cm are at increased risk of being cancerous. These patients need surgery to remove the gall bladder. As such only 0.6% of all gall bladder polyps are malignant. However when the size exceeds 1 cm the risk of developing cancer increases.
• Focal thickening and irregularity / induration on the gall bladder wall - as seen on ultrasound and imaging may be associated with gall bladder cancer - and will require a cholecystectomy

Symptoms & Diagnosis

Incidental Gall Bladder Cancer

• This is referred to those cancers within the gall bladder which are discovered by chance- incidentally.
• The gall bladder is almost always removed for stone disease - gall stones. when pathological examination of the gall bladder is done - a cancer within it is discovered.
• This by itself is a rare occurrence, but it has been estimated that a silent cancer will reside in 0.2-3% of all cholecystectomies done
• Once this diagnosis has been established the patient would need detailed imaging and tests - CT scan / PET- CT scan ,etc to determine the stage of the disease and plan further treatment .
• The precise treatment plan will depend on the presence / absence of metastatic disease, lymph nodes  and local extent of disease
• In most instances wherein the cancer is localised to the gall bladder (which is usually the case), further surgery is usually required

Only 30% of all gall bladder cancers are discovered preoperatively (non incidental). The patient may present with vague symptoms including pain, vommiting, weight loss, jaundice.

When further investigated with ultrasound and further tests, the diagnosis can be made.

Accurate diagnosis of gall bladder cancer is made on CT scanning. Further imaging (PET-CT) will be required to rule out metastases. CT scan is an accurate modality to stage the disease and define further treatment which is stage dependant.

Treatment

Surgery is the only definitive treatment with potential for cure - for gall bladder cancer. Hence wherever possible, surgery should be done

Furthermore, surgery is only done, when the cancer has remain localised to the gall bladder and the surrounding structures including regional lymph nodes and has not extensively spread to either within the abdomen or elsewhere.

Since the gall bladder resides at the base of the liver - surgery for gall bladder cancer involves

• Removal of the gall bladder
• Removal of part of the liver wherein the gall bladder resides (segment 4b/5)
• Regional draining lymph nodes

Sometimes more extensive surgery will be required to remove the cancer.

Chemotherapy

Surgery remains the cornerstone of management of gall bladder cancer. However chemotherapy does have a role in treatment and would be required following surgery. Chemotherapy is also sometimes required preoperatively prior to surgery.