Different surgical methods for advanced primary gallbladder cancer

Primary gallbladder cancer is highly malignant. Clinically, the surgical methods that can be used include standard radical surgery, extended radical surgery, palliative surgery and simple biopsy according to the different conditions of the patients.

(1) Standard radical surgery: complete cholecystectomy, wedge resection of liver tissue more than 2 cm deep in the gallbladder bed, and clearance of the first station lymph nodes (lymph nodes around the cystic duct, common bile duct, and hilar lymph nodes) and part of the second station lymph nodes (lymph nodes around the pancreatic head, duodenum, portal vein, celiac artery, and superior mesenteric artery).

(2) Extended radical mastectomy: Based on the standard radical mastectomy, the first and second lymph nodes are cleared more extensively, and adjacent organs are additionally removed according to the condition, such as liver segment, liver lobe, stomach, colon, pancreas, and duodenum resection.

(3) Palliative resection: cholecystectomy or additional internal or external biliary drainage.

(4) Laparotomy and biopsy: A combination of laparotomy exploration and biopsy, with examination performed after laparotomy to determine the surgical plan and necessity.

For example, for patients with distant lymph node metastasis, the efficacy of extended radical surgery is poor. Therefore, intraoperative frozen biopsy can be performed if necessary to clarify whether extended radical surgery is necessary. Whether distant lymph node metastasis is the main indicator for determining whether extended radical surgery is performed, so special attention should be paid during the examination. For patients with advanced gallbladder cancer, active laparotomy and radical surgery can prolong the survival of some patients.