What Should Be Done If Cancer Is Found In Gall Bladder After Gall Bladder Stone Surgery?

20 Jan, 2023

What is incidental gall bladder cancer?

Incidental gall bladder cancer refers to cancer of gall bladder that is diagnosed during or after simple cholecystectomy performed for seemingly benign gall bladder disease. The most common indications for such simple cholecystectomy are gall bladder stone, sludge, empyema or polyps in gall bladder. In a small subset of patients (1-2%), the histopathologic examination/biopsy of the gall bladder may reveal cancer. Gall bladder cancers are known for rapid spread to other parts of body, so immediate action is needed.

What to do if gall bladder biopsy shows cancer after gall bladder removal?

Quite often, there is a lot of anxiety and stress in the patient’s family. It is important to consult a surgical team specializing in GI & HPB cancer treatment to look at the detailed biopsy report to judge the level of penetration of cancer. A PET- CT scan (and a few blood tests) aid a lot in deciding the best course of treatment from hereon.

How to manage gall bladder cancer detected on biopsy (after removal)?

The management of patients with incidental gall bladder cancer detected on biopsy depends on the stage of cancer in the removed gall bladder, and extent of disease seen on PET-CT scan. For few patients with very early stage cancer of gall bladder vigilant follow up with regular scans may be enough. Most other patients will need an additional surgery for removal of a small part of liver (to which the gall bladder was adherent) along with regional lymph nodes and removal of bile duct if cystic duct margin was positive. There is some benefit of adding chemotherapy after surgery in most patients. For most patients with advanced disease, it is preferable to give chemotherapy and consider surgery only if disease is stable or responsive to treatment. To simplify, complete surgical removal of gall bladder with clear margins remains the only potentially curative option for patients with gall bladder cancer.

What is the outcome with treatment for cancer of gall bladder detected after cholecystectomy?

Fortunately, 5- year survival or cure rates for T1 incidental gall bladder cancer (stage 1) exceed 95%. More advanced T stage, or nodal positivity is associated with poorer outcomes though significant survival benefit can be obtained in these patients with modern multidisciplinary management which includes immunotherapy, radiotherapy and targeted chemotherapy with surgery for gall bladder cancer.