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
- Program Co-Director, GI Cancers, Mayo Clinic Cancer Center
- Senior Associate Consultant , Mayo Clinic, Phoenix AZ
- Professor, Mayo College of Medicine and Science
- 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. (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 GBCs are 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
The current (eighth) edition of the American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging criteria contains several changes compared with the earlier 2010 edition (table 1) . The most important are the subdivision of T2 disease into two categories based upon whether the tumor has arisen on the peritoneal or the hepatic side of the gallbladder, and a change from location-based definitions to a number-based N category assessment. Observed survival rates from a multicenter series of 437 cases of gallbladder cancer (GBC), stratified according to stage using the eighth edition staging criteria, are depicted in the figure (figure 1) . (See "Gallbladder cancer: Epidemiology, risk factors, clinical features, and diagnosis", section on 'TNM staging system'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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