Abstract
Gallbladder cancer is rare; the incidence is approximately 1.4/100,000 in females and 0.8/100,000 in males. In the United States, 5000 cases are reported annually, with 2800 deaths per year. Gallbladder cancer is found in 1% of cholecystectomy specimens. Risk factors include the chronic presence of large gallstones, chronic cholecystitis, porcelain gallbladder (cancer risk 2%–3%), large gallbladder polyps (>1 cm), female sex, Alaskan American or Native American heritage, and obesity. Gallbladder cancer staging dictates resectability as well as extent of operative resection. Thus, careful pathological examination of gallbladder specimens, and high-quality imaging (if incidental gallbladder carcinoma is found) is important in planning for treatment. Cholecystectomy is adequate treatment in patients with T1a disease. In cases of T1b disease, lymph node metastases develop in 11% of patients. Therefore, radical cholecystectomy is recommended. T3/T4 lesions are advanced and have poor prognosis. In carefully selected cases, major hepatic resection may be performed. Operative morbidity and mortality are notoriously high. Unresectable disease includes patients with distant metastases, peritoneal surface malignancy, malignant ascites, and vessels encased in tumor.
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