Gallbladder cancer: Historical treatment and new management options

Table 4 Surgical procedures performed for gallbladder cancer

Procedure	Description	Indications
Curative procedures
Simple cholecystectomy	Dissection, ligation, and transection of cystic duct and artery at the level of Calot triangle and dissection of the cystic plate	Benign gallbladder conditions, gallbladder polyps, porcelain gallbladder, GBC (T0, Tis, and T1a)
Extended cholecystectomy	Simple cholecystectomy + hepatic wedge resection at the level of gallbladder fossa (2-3 cm in depth)	T1b and higher GBC
IVb/V hepatic bisegmentectomy	Resection of liver segments IVb and V en bloc with the gallbladder with intra-parenchymal transection of the middle hepatic vein	GBC invading liver parenchyma
Extended liver resections	Most commonly right hepatectomy, rarely left hepatectomy	GBC invading structures of porta hepatis
Bile duct resection	Resection of the extrahepatic bile duct + Roux-en-Y hepaticojejunostomy	GBC invading extrahepatic bile ducts or positive cystic duct margin at frozen section pathology
Lymphadenectomy	Removal of lymph nodes from N1 and N2 zones	T1b and higher GBC, N+ GBC
Multivisceral resection	May involve right colectomy, pancreaticoduodenectomy, resection of abdominal wall, etc.	Locally advanced GBC
Palliative procedures
Biliodigestive anastomoses	Roux-en-Y hepaticojejunostomy	Locally advanced unresectable GBC presenting with jaundice
Digestive anastomoses	Gastro-enteric anastomosis, ileo-transverse colon anastomosis	Locally advanced unresectable GBC presenting with intestinal obstruction

GBC: Gallbladder cancer.