Gallbladder Cancer Surgery

Cancer found after gallbladder removal

The approach depends on how deeply the tumor has invaded the gallbladder wall:

• the tumor is confined to the mucosal layer (T1a) and the cystic duct margin is clear — the standard gallbladder removal is usually sufficient, followed by surveillance;
• the tumor has invaded the muscle layer or deeper (T1b and above) — a radical re-resection is recommended if there are no distant metastases and the patient’s condition allows it.

The second operation is performed after additional workup, once the acute effects of the first one have settled — usually after several weeks. Before it, contrast-enhanced CT of the chest, abdomen and pelvis and liver MRI are needed, along with CA 19-9 and CEA tumor markers, and if the pathology report is incomplete or doubtful, a review of the slides in another laboratory.

About the disease itself, risk factors and gallbladder polyps — on the page “Gallbladder Cancer”.

Cancer suspected before surgery

If the tumor appears operable, a percutaneous biopsy is usually not performed: the diagnosis is confirmed on the removed specimen. The gallbladder is removed en bloc with the liver without being opened, so that tumor cells do not spill into the abdomen. The conditions are the same: no distant metastases, and the tumor can be removed with clear margins.

Before a major operation, when there is an increased risk of peritoneal spread not visible on CT, diagnostic laparoscopy is performed.

If surgery is not possible right now

With distant metastases, tumor deposits on the peritoneum or spread that does not allow complete removal of the tumor, systemic therapy becomes the basis of treatment: the first-line standard for patients in satisfactory general condition is chemotherapy combined with immunotherapy. For some patients, molecular testing of the tumor opens up the option of targeted treatment.

If the tumor blocks bile drainage or the bowel, the way to relieve it — a stent, percutaneous drainage or a bypass operation — is chosen individually. Sometimes the tumor shrinks enough after treatment that the question of surgery returns; the final approach is decided by the tumor board.

How the operation is performed

Radical surgery includes removal of the part of the liver the gallbladder was attached to — usually segments IVb and V or a wedge resection of the gallbladder bed with a margin of healthy tissue — and of the regional lymph nodes: of the hepatoduodenal ligament, along the common hepatic artery and behind the head of the pancreas. At least six nodes are examined for accurate staging.

The bile duct is not always removed, only when tumor is present at the cystic duct margin or extends onto it; in that case bile drainage is restored through a loop of small bowel. For more extensive tumors the extent of liver resection is increased.

When the tumor location and extent of resection allow it, the operation is performed laparoscopically — through several small incisions.

Hospital stay, recovery and further treatment

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. After resection of the gallbladder bed without removal of the bile duct, recovery is usually faster than after major liver resections; after bile duct reconstruction the hospital stay is longer.

After radical surgery adjuvant chemotherapy is usually discussed; its regimen is set by the oncologist based on the pathology report. In the first years CT or MRI and tumor markers are done regularly, every few months, and later less often.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• bile leak from the liver resection surface or the duct-to-bowel anastomosis;
• bleeding during or after the operation;
• infection and general surgical complications, including thrombosis;
• in a repeat operation — technical difficulties because of adhesions after the first procedure.

The likelihood of each depends on the extent of the operation, whether the bile ducts are reconstructed, and your general condition. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of liver resection, whether the bile duct is removed, the approach, the number of days in the hospital and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• pathology report on the removed gallbladder with depth of invasion and cystic duct margin status, tissue blocks and slides;
• the discharge summary and operative report of the first operation: open or laparoscopic, whether the gallbladder was opened;
• CT or MRI discs and reports, ultrasound before surgery;
• CA 19-9 and CEA tumor markers, blood chemistry.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.