Journal of Surgery Concepts & Practice >
Controversial points in the surgical treatment of gallbladder cancer with delayed diagnoses
Received date: 2025-01-29
Online published: 2025-07-07
Gallbladder cancer with delayed diagnoses, as a malignant tumor diagnosed intraoperatively or postoperatively incidentally in benign gallbladder diseases, radical surgical treatment is its core treatment, and the necessity of re-operation, timing of surgery, choice of surgical procedure, definition of resection extent, and preoperative neoadjuvant therapy still remain controversial. Re-operation for gallbladder cancer with delayed diagnoses needs to balance tumor radicalization, postoperative risk, and survival benefit, and combining neoadjuvant therapy to facilitate radical treatment, and develop individualized protocols. The multidisciplinary team should integrate innovative technologies and multi-center prospective studies to promote the development of precise treatment strategies for gallbladder cancer with delayed diagnoses and optimize the survival of patients.
LE Sen , ZUO Yue , DENG Zhengdong , WANG Jianming . Controversial points in the surgical treatment of gallbladder cancer with delayed diagnoses[J]. Journal of Surgery Concepts & Practice, 2025 , 30(2) : 106 -111 . DOI: 10.16139/j.1007-9610.2025.02.03
| [1] | BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263. |
| [2] | ROA J C, GARCíA P, KAPOOR V K, et al. Gallbladder cancer[J]. Nat Rev Dis Primers, 2022, 8(1):69. |
| [3] | 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专业委员会. 胆囊癌诊断和治疗指南(2019版)[J]. 中华外科杂志, 2020, 58(4):243-251. |
| Biliary Surgery Group of Surgery Branch of Chinese Medical Association, Biliary Surgery Professional Committee of the Surgical Branch of the Chinese Medical Association. Guideline for the diagnosis and treatment of gallbladder carcinoma (2019 edition)[J]. Chin J Surg, 2020, 58(4):243-251. | |
| [4] | 中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专家工作组. 腹腔镜胆囊癌根治性切除专家共识(2023)[J]. 中华外科杂志, 2024, 62(4):265-272. |
| Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association, Chinese Medical Doctor Association in Chinese Committee of Biliary Surgeons. Expert consensus on the laparoscopic radical resection of gallbladder cancer(2023)[J]. Chin J Surg, 2024, 62(4):265-272. | |
| [5] | LV T R, WANG J K, LI F Y, et al. Prognostic factors for resected cases with gallbladder carcinoma: a systematic review and meta-analysis[J]. Int J Surg, 2024, 110(7):4342-4355. |
| [6] | AYABE R I, WACH M M, RUFF S M, et al. Gallbladder squamous cell carcinoma: an analysis of 1084 cases from the national cancer database[J]. J Surg Oncol, 2020, 122(4):716-722. |
| [7] | ZOU R Q, HU H J, LV T R, et al. Clinicopathological characteristics and outcome of primary sarcomatoid carcinoma of the gallbladder[J]. Front Oncol,2022, 12:1009673 |
| [8] | LEIGH N, SOLOMON D, PLETCHER E, et al. Adeno-squamous and squamous cell carcinoma of the gallbladder: the importance of histology in surgical management[J]. Am J Surg, 2020, 220(5):1242-1248. |
| [9] | LEE H, KWON W, HAN Y, et al. Optimal extent of surgery for early gallbladder cancer with regard to long-term survival: a meta-analysis[J]. J Hepatobiliary Pancreat Sci, 2018, 25(2):131-141. |
| [10] | KIM B H, KIM S H, SONG I S, et al. The appropriate surgical strategy for T1b gallbladder cancer incidentally dia-gnosed after a simple cholecystectomy[J]. Ann Hepatobiliary Pancreat Surg, 2019, 23(4):327-333. |
| [11] | WANG Z, LI Y, JIANG W, et al. Simple Cholecystectomy is adequate for patients with T1b gallbladder adenocarcinoma < 1 cm in diameter[J]. Front Oncol,2019, 9:409 |
| [12] | SHAO J, LU H C, WU L Q, et al. Simple cholecystectomy is an adequate treatment for grade Ⅰ T1bN0M0 gallbladder carcinoma: evidence from 528 patients[J]. World J Gastroenterol, 2022, 28(31):4431-4441. |
| [13] | MATSUYAMA R, MATSUO K, MORI R, et al. Incidental gallbladder cancer on cholecystectomy: strategy for re-resection of presumed benign diseases from a retrospective multicenter study by the Yokohama clinical oncology group[J]. In Vivo, 2021, 35(2):1217-1225. |
| [14] | KWON W, KIM H, HAN Y, et al. Role of tumour location and surgical extent on prognosis in T2 gallbladder cancer: an international multicentre study[J]. Br J Surg, 2020, 107(10):1334-1343. |
| [15] | SUNG M K, LEE W, LEE J H, et al. Comparing survival rate and appropriate surgery methods according to tumor location in T2 gallbladder cancer[J]. Surg Oncol,2022, 40:101693 |
| [16] | LEE W, JEONG C Y, JANG J Y, et al. Do hepatic-sided tumors require more extensive resection than peritoneal-sided tumors in patients with T2 gallbladder cancer? Results of a retrospective multicenter study[J]. Surgery, 2017, 162(3):515-524. |
| [17] | ETHUN C G, POSTLEWAIT L M, LE N, et al. A novel pathology-based preoperative risk score to predict locoregional residual and distant disease and survival for incidental gallbladder cancer: a 10-institution study from the U.S. extrahepatic biliary malignancy consortium[J]. Ann Surg Oncol, 2017, 24(5):1343-1350. |
| [18] | GOINS S, RHODIN K E, ECKHOFF A M, et al. Prognostic factors for patients with T2/T3 gallbladder cancer: does extent of resection matter?[J]. Surg Oncol Insight, 2025, 2(1):100126. |
| [19] | S?REIDE K, GUEST R V, HARRISON E M, et al. Systematic review of management of incidental gallbladder cancer after cholecystectomy[J]. Br J Surg, 2019, 106(1):32-45. |
| [20] | ETHUN C G, POSTLEWAIT L M, LE N, et al. Association of optimal time interval to re-resection for incidental gallbladder cancer with overall survival: a multi-institution analysis from the US extrahepatic biliary malignancy consortium[J]. JAMA Surgery, 2017, 152(2):143-149. |
| [21] | SHAH S, SWEENEY R, WEGNER R E. Survival benefit with re-resection and optimal time to re-resection in gallbladder cancer: a national cancer database study[J]. J Gastrointest Cancer, 2023, 54(4):1331-1337. |
| [22] | DU J, YANG X W, WEN Z J, et al. Relationship between prognosis and time interval from cholecystectomy to re-operation in postoperative incidental gallbladder carcinoma[J]. Chin Med J (Engl), 2018, 131(20):2503-2505. |
| [23] | 林轩涵, 田一童, 陈浙涵, 等. T1b/T2期胆囊癌根治性手术中肝切除术时机与临床疗效及预后的关系[J]. 中国普通外科杂志, 2024, 33(2):227-235. |
| LIN X H, TIAN Y T, CHEN Z H, et al. Relations of timing of hepatectomy with clinical efficacy and prognosis in radical surgery for T1b/T2 stage gallbladder cancer[J]. China J Gen Surg, 2024, 33(2):227-235. | |
| [24] | BERGER-RICHARDSON D, CHESNEY T R, ENGLESAKIS M, et al. Trends in port-site metastasis after laparoscopic resection of incidental gallbladder cancer: a systematic review[J]. Surgery, 2017, 161(3):618-627. |
| [25] | LI D, XU L, DENG X, et al. Laparoscopic versus open surgery in treating patients with gallbladder cancer: a systematic review and meta-analysis[J]. Hepatobiliary Surg Nutr, 2024, 13(3):444-459. |
| [26] | REGMI P, HU H J, CHANG H Y, et al. Laparoscopic surgery for oncologic extended resection of T1b and T2 incidental gallbladder carcinoma at a high-volume center: a single-center experience in China[J]. Surg Endosc, 2020, 35(12):6505-6512. |
| [27] | MASIOR ?, KRASNOD?BSKI M, KRUK E, et al. Open versus laparoscopic oncologic resection for gallbladder cancer after index cholecystectomy: international multicenter comparative study[J]. Langenbecks Arch Surg, 2025, 410(1):74. |
| [28] | HORKOFF M J, AHMED Z, XU Y, et al. Adverse outcomes after bile spillage in incidental gallbladder cancers: a population-based study[J]. Ann Surg, 2021, 273(1):139-144. |
| [29] | ETHUN C G, POSTLEWAIT L M, LE N, et al. Routine port-site excision in incidentally discovered gallbladder cancer is not associated with improved survival: a multi-institution analysis from the US extrahepatic biliary malignancy consortium[J]. J Surg Oncol, 2017, 115(7):805-811. |
| [30] | VEGA E A, DE ARETXABALA X, QIAO W, et al. Comparison of oncological outcomes after open and laparoscopic re-resection of incidental gallbladder cancer[J]. Br J Surg, 2020, 107(3):289-300. |
| [31] | ZENG D, WANG Y, WEN N, et al. Incidental gallbladder cancer detected during laparoscopic cholecystectomy: conversion to extensive resection is a feasible choice[J]. Front Surg,2024, 11:1418314 |
| [32] | YOU C, XIE M, LING M, et al. Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer[J]. BMC Surg, 2022, 22(1):443. |
| [33] | BENSON A B, D'ANGELICA M I, ABRAMS T, et al. NCCN Guidelines? insights: biliary tract cancers, version 2.2023[J]. J Natl Compr Canc Netw, 2023, 21(7):694-704. |
| [34] | PARK Y, LEE J S, LEE B, et al. Prognostic effect of liver resection in extended cholecystectomy for T2 gallbladder cancer revisited: a retrospective cohort study with propensity score-matched analysis[J]. Ann Surg, 2023, 278(6):985-993. |
| [35] | MATSUI S, TANIOKA T, NAKAJIMA K, et al. Surgical and oncological outcomes of wedge resection versus segment 4b?+?5 resection for T2 and T3 gallbladder cancer: a meta-analysis[J]. J Gastrointest Surg, 2023, 27(9):1954-1962. |
| [36] | CHEN M, CAO J, XIANG Y, et al. Hepatectomy strategy for T2 gallbladder cancer between segment Ⅳb and Ⅴ resection and wedge resection: a propensity score-matched study[J]. Surgery, 2021, 169(6):1304-1311. |
| [37] | VOGEL A, BRIDGEWATER J, EDELINE J, et al. Bi-liary tract cancer: ESMO clinical practice guideline for diagnosis, treatment and follow-up[J]. Ann Oncol, 2023, 34(2):127-140. |
| [38] | ALRAWASHDEH W, KAMARAJAH S K, GUJJURI R R, et al. Systematic review and meta-analysis of survival outcomes in T2a and T2b gallbladder cancers[J]. HPB (Oxford), 2022, 24(6):789-796. |
| [39] | YOU D D, PAIK K Y, WOO Y K, et al. Accuracy of preoperative T2 gallbladder tumor localization and the adequate surgical resection[J]. Eur J Surg Oncol, 2024, 50(4):108049. |
| [40] | PICCOLO G, BARABINO M, PIOZZI G N, et al. Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer[J]. World J Gastroenterol, 2024, 30(32):3739-3742. |
| [41] | BENOIST S, PANIS Y, FAGNIEZ P L. Long-term results after curative resection for carcinoma of the gallbladder. French university association for surgical research[J]. Am J Surg, 1998, 175(2):118-122. |
| [42] | ?OKIC M, STUPAN U, LICEN S, et al. Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer - institution experience with literature review[J]. Radiol Oncol, 2021, 56(2):208-215. |
| [43] | KATO H, HORIGUCHI A, ISHIHARA S, et al. Clinical significance of extrahepatic bile duct resection for T2 gallbladder cancer using data from the Japanese biliary tract cancer registry between 2014 and 2018[J]. J Hepatobiliary Pancreat Sci, 2023, 30(12):1316-1323. |
| [44] | LV T R, LIU F, HU H J, et al. The role of extra-hepatic bile duct resection in the surgical management of gallbladder carcinoma. A first meta-analysis[J]. Eur J Surg Oncol, 2022, 48(3):482-491. |
| [45] | 李起, 张小弟, 张东, 等. 意外胆囊癌新辅助化疗10例疗效分析[J]. 中国实用外科杂志, 2023, 43(8):906-910. |
| LI Q, ZHANG X D, ZHANG D, et al. Efficacy analysis of neoadjuvant chemotherapy for 10 cases of incidental gallbladder cancer[J]. Chin J Pract Surg, 2023, 43(8):906-910. | |
| [46] | GOETZE T O, BECHSTEIN W O, BANKSTAHL U S, et al. Neoadjuvant chemotherapy with gemcitabine plus cisplatin followed by radical liver resection versus immediate radical liver resection alone with or without adjuvant chemotherapy in incidentally detected gallbladder carcinoma after simple cholecystectomy or in front of radical resection of BTC (ICC/ECC) - a phase Ⅲ study of the German registry of incidental gallbladder carcinoma platform (GR)-the AIO/CALGP/ACO-GAIN-trial[J]. BMC Cancer, 2020, 20(1):122. |
| [47] | OZER M, GOKSU S Y, SANFORD N N, et al. A propensity score analysis of chemotherapy use in patients with resectable gallbladder cancer[J]. JAMA Netw Open, 2022, 5(2):e2146912. |
| [48] | WHITE M J, PRATHIBHA S, GUPTA A, et al. Adjuvant therapy use for patients with inadequately resected T1b-T3 gallbladder cancer[J]. J Surg Res, 2024,302:293-301. |
/
| 〈 |
|
〉 |
