Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jul 27, 2015; 7(7): 107-109
Published online Jul 27, 2015. doi: 10.4240/wjgs.v7.i7.107
Is gall bladder cancer a bad cancer per se?
Vinay K Kapoor
Vinay K Kapoor, Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
Author contributions: Kapoor VK solely contributed to this paper.
Conflict-of-interest statement: No conflict of interests to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vinay K Kapoor, Professor of Surgical Gastroenterology, Sanjay Gandhi Post-graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, Uttar Pradesh, India. vkkapoor.india@gmail.com
Telephone: +91-522-2494401 Fax: +91-522-2668017
Received: February 6, 2015
Peer-review started: February 6, 2015
First decision: April 27, 2015
Revised: April 28, 2015
Accepted: May 16, 2015
Article in press: May 18, 2015
Published online: July 27, 2015
Abstract

Gall bladder cancer (GBC) has one of the poorest outcomes of all cancers. Early GBC is difficult to diagnose on even computed tomography. GB has no submucosa and the cancer infiltrates directly into the muscularis propria. GB wall is thin and important adjacent organs viz. liver, duodenum and pancreas get easily infiltrated. Tumor in the GB neck often needs extended right hepatectomy. Infiltration of duodenum/pancreas may necessitate pancreato-duodenectomy or even hepato-pancreato-duodenectomy. Mortality of surgical procedures, when performed for GBC, is higher than when performed for other cancers. Survival in GBC, even after R0 resection, is poor. There is no proven role of neo-adjuvant or adjuvant therapy for loco-regionally advanced GBC. There is no role of palliative surgery in metastatic GBC. Early GBC is diagnosed incidentally after cholecystectomy for stones and requires reoperation for completion extended cholecystectomy but unfortunately, most surgeons are not aware of this. GBC has a peculiar epidemiology and is uncommon in the West and has, therefore, not received much attention. Preventive cholecystectomy for asymptomatic stones is not recommended and there is no serum marker for screening. With all factors pitched against it, it does appear that GBC is a bad cancer per se!

Keywords: Gall bladder neoplasms, Cholangiocarcinoma, Cholecystectomy, Hepatectomy, Hepato-pancreato-duodenectomy

Core tip: Gall bladder (GB) wall is thin and important adjacent organs get easily infiltrated. Tumor in GB neck needs hepatectomy and infiltration of duodenum/pancreas necessitates pancreato-duodenectomy; mortality of these procedures is high. Survival in gall bladder cancer (GBC), even after R0 resection, is poor. There is no role of neo-adjuvant or adjuvant therapy. Early GBC, diagnosed incidentally after cholecystectomy for stones, requires reoperation but most surgeons are not aware of this. GBC, uncommon in the West, has not received much attention. Preventive cholecystectomy is not recommended and there is no marker for screening. GBC is a bad cancer per se!