Adjuvant treatment for localized, resected gallbladder cancer
- Bhoomi Mehrotra, MD
Bhoomi Mehrotra, MD
- Cancer Institute at St. Francis Hospital
- Roslyn, NY
- Tanios Bekaii-Saab, MD
Tanios Bekaii-Saab, MD
- Co-Director, GI program , Mayo Clinic Cancer Center
- Senior Associate Consultant , Mayo Clinic, Phoenix AZ
- Professor of Medicine, Ohio State University
- Section Editors
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
Gallbladder cancer (GBC) is an uncommon but highly fatal malignancy; fewer than 5000 new cases are diagnosed each year in the United States. Most GBC is found incidentally in patients undergoing exploration for cholelithiasis; a tumor will be found in 1 to 2 percent of such cases [1-4].
Surgery is the only potentially curative therapy for GBC. However, even after complete resection, outcomes are poor, particularly for T3 and/or node-positive disease. High rates of both local and distant recurrence have prompted interest in adjuvant chemotherapy and radiation therapy (RT). (See "Surgical management of gallbladder cancer", section on 'Outcomes' and "Surgical management of gallbladder cancer", section on 'Resectable T3/4 or node positive gallbladder cancer'.)
A high percentage of gallbladder cancers is initially unsuspected and detected at the time of laparoscopic cholecystectomy for presumed cholecystitis. The next step for these patients (before adjuvant therapy) is additional surgery to remove lymph nodes and the segments of liver above the gallbladder. (See "Surgical management of gallbladder cancer", section on 'Managing an incidental gallbladder cancer'.)
This topic review will cover adjuvant treatment for localized, resected GBC. The epidemiology, risk factors, clinical features, and diagnostic evaluation, surgical treatment, and treatment for locally advanced unresectable and metastatic GBC are covered separately, as is adjuvant treatment after resection of cholangiocarcinoma. (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis" and "Surgical management of gallbladder cancer" and "Treatment of advanced, unresectable gallbladder cancer" and "Treatment of localized cholangiocarcinoma: Adjuvant and neoadjuvant therapy and prognosis".)
PROGNOSIS AND PATTERNS OF SPREAD
Gallbladder cancer (GBC) has traditionally been associated with a poor prognosis. Observed survival rates from a series of 10,705 cases of GBC collected between 1989 and 1996 in the National Cancer Database and stratified according to stage at diagnosis (using the newest American Joint Commission on Cancer 2010 criteria (table 1) ) are provided (figure 1) .
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- PROGNOSIS AND PATTERNS OF SPREAD
- Patterns of disease recurrence
- ADJUVANT THERAPY
- Radiation and chemoradiotherapy
- Adjuvant IORT
- Chemotherapy alone
- - Choice of regimen
- Chemotherapy alone versus chemoradiotherapy
- - Meta-analysis
- - Prediction models
- - Guidelines from expert groups
- POSTTREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS