• 5% overall survival
• Risk factors
–Gallstones (70–90% of patients have gallstones)
–Native American heritage
–Stones > 3 cm (10-fold increased risk)
–Porcelain gallbladder (at least 25% develop cancer)
–Gallbladder adenoma > 1 cm
• 0.5% of patients with cholelithiasis have adenocarcinoma
• 1% of patients undergoing elective cholecystectomy have unsuspected adenocarcinoma identified
• Only 25% of patients have chance for curative resection
• 6000–7000 cases annually
• 3:1 female:male ratio
• Peak incidence in seventh decade
• Risk is at least 5% among Native Americans who have gallstones
• Cholecystectomy (T1 tumors—limited to muscular wall)
• Cholecystectomy with segment 4b, 5 liver resection and portal lymphadenectomy (T2 tumors—invasion to perimuscular tissue but not to serosa)
• Right extended hepatectomy (for some T3 and T4s and recurrence after cholecystectomy or 4b, 5 segmental resection)
• Right extended hepatectomy and resection of CBD followed by hepaticojejunostomy for invasion into CBD
• CEA levels
• US or CT scanning
• 5-year survival with resection for curative intent, 17%
• > 95% survival for T1 tumors treated with cholecystectomy
• Range from 70% to > 90% for T2 and T3 if 4b and 5 segment resections performed and no nodal involvement
Kondo S et al. Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg.
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