Surgery is the main treatment for gallbladder cancer. Surgery is used to:
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:
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.
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.
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:
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.
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:
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:
To remove as much of the cancer as possible, doctors may sometimes take out other organs around the gallbladder. These surgeries include:
There are more risks and complications associated with these procedures than less extensive surgeries.
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.
Stents may be used for people with advanced gallbladder cancer who are:
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).
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.