Aggressive surgical approach to treat Gallbladder cancer: is it worth it?

ABSTRACT

The treatment of locally advanced gallbladder cancer has shifted in the past years, leading to a more aggressive surgical approach. We report a case of a 61-year-old woman diagnosed as having a locally advanced gallbladder cancer who was submitted to an aggressive surgical procedure in order to achieve complete resection (R0 resection). At laparotomy, a huge gallbladder tumor was seen with gross invasion of the transverse colon, distal part of stomach, pancreatic head, duodenum and liver. No distant metastases were seen. Surgical approach consisted in an en bloc tumor resection, including pancreatoduodenectomy, distal gastrectomy, right colectomy, hepatic resection (segments IVb, V and VI) and radical lymphadenectomy. The final pathology report revealed adenocarcinoma of the gallbladder with invasion to the nearby organs (liver, stomach, duodenum, head of the pancreas and colon) and no lymph nodes metastases (T4N0M0). All margins were free (R0 resection). Adjuvant chemotherapy was given (cisplatin and gemcitabine). The patient had been well (asymptomatic and with good quality of life) for 10 months when developed liver metastases not amenable to resection. The patient is being treated with palliative chemotherapy (gemcitabine and oxaliplatin). A marked improvement in outcome (survival and quality of life) of patients with gallbladder cancer has been achieved over the past years, primarily due to a shift towards more aggressive surgery. Therefore, this approach might be beneficial for selected patients with locally advanced gallbladder cancer.