Treatment of Resectable Gallbladder Carcinoma with No Metastatic Spread

Clinical scenario

This protocol applies to patients with gallbladder carcinoma (GBC) where imaging and evaluation confirm no distant metastatic spread and the tumour is considered surgically resectable. Determining resectability is the central step: when GBC is diagnosed on imaging or when patients present with jaundice, assessment of potential resectability guides all subsequent management decisions. This assessment should be carried out by a specialist hepatobiliary multidisciplinary tumour board.

Treatment approach (overview)

Surgery is the only modality with the potential to cure this disease. The approach involves radical curative-intent resection, which includes removal of regional lymph nodes (lymphadenectomy). The specific extent of the resection depends on tumour location and the degree of local invasion — additional structures beyond the gallbladder itself may need to be addressed to achieve the surgical goal.

The complete surgical algorithm, including the specific anatomical resection criteria for each tumour location, is available in the full structured protocol.

Surgical goal

The primary objective of the operation is:

R0 resection — no tumour at the resection margin

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.annonc.2022.10.506

If GBC is diagnosed during imaging (for symptomatic patients) or when patients present with jaundice, evaluation of potential resectability is the key factor.
Surgery is, at present, the only modality that can cure BTC and should be agreed by a specialist hepatobiliary multidisciplinary tumour board.
Radical surgery, which includes lymphadenectomy, is the only curative-intent treatment for BTC.
Basic surgical principles apply, thus resection with no tumour at the margin (R0) is the aim.
Resection of some or all of segment IVb/V of the liver, depending on the extent of invasion, is carried out together with a lymphadenectomy of the hepatoduodenal ligament.
Curative-intent resection of tumours located at the infundibulum requires resection of the bile duct, the duodenal bulb and, potentially, the pancreatic head.

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