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Gallbladder cancer

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Surgery for gallbladder cancer

Surgery is the main treatment for gallbladder cancer. Surgery is used to:

  • potentially cure the cancer by completely removing the tumour
  • reduce pain and relieve symptoms or blockages caused by an advanced gallbladder tumour (palliative treatment)

Imaging tests often show if the gallbladder tumour can be removed by surgery (is resectable). Only a small number of gallbladder tumours are resectable at the time of diagnosis. Surgery usually isn't an option if the cancer is at an advanced stage and has spread to any of the following:

  • both sides of the liver
  • the lining of the abdominal cavity (peritoneum)
  • major blood vessels
  • organs far from the gallbladder

The type of surgery done depends mainly on the location and stage of the gallbladder cancer, as well as other factors like a person’s age and overall health. Side effects of surgery depend on the type of surgical procedure.

Pre-surgical evaluation

People with gallbladder cancer may be evaluated to see if they are healthy enough to have surgery. The more extensive the surgery, the more important it is that the person is healthy. Surgery would not benefit people with gallbladder cancer who are in poor health and may not be able to tolerate the surgery or the long recovery period afterward.

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Laparoscopic surgery

Laparoscopic surgery uses a long, flexible tube (a laparoscope) inserted through small cuts (incisions) in the abdomen. A laparoscopic cholecystectomy is done to remove the gallbladder for non-cancerous (benign) conditions, such as gallstones or chronic inflammation. Many gallbladder cancers are discovered when an elective laparoscopic surgery is done for gallstones or inflammation.

Laparoscopic surgery is not done if gallbladder cancer is suspected before surgery. If the gallbladder is removed through the small incisions, there is a chance that cancer cells can be squeezed out of the gallbladder and spread into the abdomen or along the incisions (port sites) used for the surgery.

If cancer is found during a laparoscopic procedure initially being done for a benign gallbladder condition, the surgeon will change the operation to an open cholecystectomy to reduce the chance of leaving any cancer behind.

Sometimes cancer is found in the gallbladder after it has been removed with laparoscopic surgery and examined by a pathologist. Additional surgery may be needed:

  • to re-explore the area to see if there is any cancer remaining (residual disease) or if it has spread into nearby tissues or structures
  • especially if there is a chance that the cancer has spread beyond the gallbladder

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Simple cholecystectomy

When gallbladder cancer is suspected, surgery is usually done through a 10–17.5 cm (4–7 inch) cut (incision) in the upper-right part of the abdomen while the person is under general anesthetic. The incision in the abdomen is opened so the surgeon can remove the gallbladder (open cholecystectomy), lessening the chance of spreading cancer cells into the abdomen.

A simple cholecystectomy removes the gallbladder. No other tissues or organs are removed during this procedure. A simple cholecystectomy is done for very early stage gallbladder cancers (such as Tis or T1), when the tumour is confined to the gallbladder or localized.

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Extended cholecystectomy

An extended (radical) cholecystectomy is a more extensive and complex surgery. It is done when cancer has spread throughout the gallbladder. An extended cholecystectomy removes:

  • the gallbladder
  • a small section (about 2.5 cm or 1 inch) of liver tissue next to the gallbladder
  • all the lymph nodes around the gallbladder (regional lymph nodes)
  • tissue surrounding the site of previous laparoscopic surgery to the gallbladder

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Radical resection

If the cancer has spread outside the gallbladder, but doctors believe that the cancer can be completely removed, they may do a radical resection. A radical resection removes even more of the surrounding tissue than an extended cholecystectomy. A radical resection removes:

  • the gallbladder
  • a small wedge-shaped section of the liver near the gallbladder
  • the cystic or common bile duct
  • part of the ligament (band of tissue) between the liver and the intestines
  • lymph nodes from around nearby organs, such as the pancreas and nearby blood vessels

To remove as much of the cancer as possible, doctors may sometimes take out other organs around the gallbladder. These surgeries include:

  • Whipple procedure (pancreaticoduodenectomy)
    • Along with the gallbladder and part of the bile duct, part of the pancreas, the first part of the small intestine (duodenum) and part of the stomach are removed.
    • After these organs are removed, the surgeon attaches the remaining end of the stomach to the small intestine (gastrojejunostomy).
    • The bile duct and the remainder of the pancreas are attached to the small intestine.
  • liver (hepatic) resection
    • Part of the liver may be removed (hepatic resection) if the cancer has spread from the gallbladder to the liver. This is done if the cancer is small, does not affect any major blood vessels and can be completely removed by surgery. Doctors may need to remove a complete lobe of the liver (hepatic lobectomy).
  • hepatopancreatoduodenectomy (HPD)
    • HPD is aggressive surgery that removes some liver tissue along with the organs and structures removed during a Whipple procedure (pancreaticoduodenectomy). Doctors may consider this surgery in some cases of advanced gallbladder cancer.

There are more risks and complications associated with these procedures than less extensive surgeries.

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Palliative surgery and procedures

Palliative surgery or procedures are done for gallbladder cancer that is widespread and cannot be removed by surgery. These procedures relieve symptoms, such as jaundicejaundiceA condition in which the skin and whites of the eyes become yellow and urine is dark yellow. and pain. Jaundice can occur if the tumour causes a blockage (obstruction) in the bile duct or gallbladder, which blocks the flow of bile into the small intestine and causes it to build up.


A stent is a small metal or plastic tube placed into the bile duct. Most stents are made of an expandable wire mesh. The stent helps keep the bile duct open and allows bile to flow into the small intestine.

  • The most common way to insert a stent to relieve a blockage of the bile duct is an endoscopy. The stent is put into place during an endoscopic retrograde cholangiopancreatography (ERCP). Stents may also be inserted during a surgical procedure, though this is not as common as endoscopic stent placement.
  • Another way to place a stent is through the abdomen using an x-ray to guide the doctor during the procedure (percutaneous transhepatic cholangiography or PTC). A needle is inserted through the skin into the gallbladder and dye is injected into the bile ducts through the needle. The dye helps show blockages in the biliary tract so the doctor knows where to place the stent. The doctor then uses a guide wire to insert the stent. Once the stent is in place, the needle and guide wire are removed.

Stents may be used for people with advanced gallbladder cancer who are:

  • in a weakened physical condition
  • not well enough to have surgery

Doctors may need to replace stents after a few months if they become blocked.


Sometimes a tube (catheter) can be used to help drain bile from around a blockage. The catheter drains the bile into a bag outside the body. The catheter is usually secured to skin with a stitch (suture). Most often, doctors insert a biliary catheter like a stent, using percutaneous transhepatic cholangiography (PTC).

Biliary bypass

A biliary bypass is an operation that creates a drainage route for bile around a blockage. A biliary bypass redirects the flow of bile around the tumour, often by attaching the common bile duct directly to the jejunum (the first part of the small intestine). Different types of bypasses may be done depending on where the blockage occurs.

Doctors may offer a biliary bypass procedure to people with advanced gallbladder cancer who are healthy enough to tolerate an operation when a stent isn't possible or doesn't work to relieve jaundice.

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See a list of questions to ask your doctor about surgery.


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