Abstract

Dr. Abhijit Sarma and Dr. Purujit Choudhury*

ABSTRACT

GBC is an “Indian disease” and Indian surgeons have to be prepared to accept the ?challenge? of GBC. Gallbladder cancer (GBC) is common in Northern India. And probably highest in the world. The western world has a pessimistic attitude towards GBC resulting in inadequate management of even early GBC. At the other extreme is the Japanese aggressiveness with high mortality but very few actual long-term survivors. The Indian surgeons have adopted a Buddhist ?middle path? — aggressive surgical approach for ?less advanced? GBC and non-surgical palliative approach for ?more advanced? GBC. As we know gallbladder cancer (GBC) is the fifth most common cancer of the gastrointestinal tract and the most common cancer of the biliary tract worldwide. T1, T2 (early GBC) and some T3 are treated with extended cholecystectomy (en-bloc resection of liver and lymph node dissection of the hepatoduodenal ligament) with or without resection of the common bile duct. There is a different of opinion regarding the extent of liver resection for GBC among the surgeons that ranges from non anatomical wedge resection of the gallbladder bed or an anatomical liver resection of segment IVb and V, to an extended hepatectomy for advanced GBC. However, what constitutes an optimal extent of liver resection for the early operable GBC remains a matter of contention and largely depends on the surgeon’s preference with no strong evidence available supporting the superiority of one technique over another. The results in terms of disease outcome and survival are comparable and hence need a meticulous study to achieve standardization. This review summarizes in brief the present literature on the subject. Staging laparoscopy to detect metastatic deposits on liver, peritoneum and omentum, and upper gastrointestinal endoscopy (UGIE) to detect duodenal infiltration which indicates unresectability and majority do not perform pancreaticoduodenectomy for GBC. The favored procedure is extended cholecystectomy (EC) which includes a 2-3 cm non-anatomical wedge of liver in the GB bed and the lymph nodes in hepatoduodenal ligament, behind the duodenum and head of pancreas and along the hepatic artery to the right of celiac axis. EC can achieve R0 resection in patients with T1-T2 and T3 disease.