Gallbladder cancer refers to malignant tumors originating from the gallbladder, with adenocarcinoma accounting for the highest proportion, followed by squamous carcinoma, mixed carcinoma and undifferentiated carcinoma. Its prognosis is poor because of its high malignancy, easy early metastasis, difficult early detection and insensitivity to chemotherapy drugs. Clinical manifestations 1. Gastrointestinal symptoms: most patients have dyspepsia, aversion to greasy food, belching and reduced gastric intake; 2. Pain in the right upper abdomen: more than 80% of patients show symptoms similar to gallbladder stones and cholecystitis, such as discomfort in the right upper abdomen followed by persistent vague or dull pain, sometimes with paroxysmal sharp pain and radiating to the right shoulder; 3. Jaundice: It often appears in the late stage of the disease, due to the bile duct obstruction caused by the invasion of cancerous tissues into the bile ducts or the compression of the bile ducts by metastatic enlarged lymph nodes, mostly accompanied by unrelieved itchy skin. Advanced patients are often accompanied by wasting and even cachexia. Diagnosis B ultrasound: Ultrasound examination is easy, non-invasive and can be used repeatedly, and its diagnostic accuracy is over 90%. Ultrasonography can help determine whether there is cancer by observing the blood flow of the lesion, and can observe whether there are obvious lymph node metastases and whether the liver is involved. CT: Enhanced CT examination is of great significance for the diagnosis of gallbladder cancer, and those who suspect gallbladder cancer should routinely undergo CT examination. CT image changes of gallbladder cancer can be divided into three types: 1. wall-thickness type: limited or diffuse irregular thickening of gallbladder wall; 2. nodular type: papillary nodules protruding from gallbladder wall into the cavity; 3. solid type: substantial mass formed by extensive infiltration and thickening of gallbladder wall by tumor plus filling of tumor in the cavity. Enhanced CT is also meaningful in determining the stage of gallbladder cancer, which can observe the extent of tumor invasion to liver and surrounding tissues, and determine whether there is regional lymph node enlargement. Magnetic resonance imaging (MRI): MRI is generally not the first choice or necessary test for gallbladder cancer, but can be considered when it is necessary to determine whether the lesion involves the liver or when the patient has obstructive jaundice. PET-CT: It can help to make qualitative diagnosis of occupying gallbladder lesions and determine whether there are lesions other than the gallbladder, but it is more expensive, and when combined with However, it is more expensive and prone to false positive results when combined with acute cholecystitis, so it is not usually done as a routine test. Laboratory tests: When a gallbladder lesion becomes cancerous, it is usually accompanied by an increase in tumor marker levels. Checking whether serum tumor markers (CEA, CA125, CA19-9, CA724, CA153) are elevated is helpful for qualitative diagnosis of gallbladder cancer, among which CA199 in particular has high specificity. Treatment Surgical resection is the first choice for early-stage gallbladder cancer. As long as the patient’s general condition permits, surgical resection of the diseased gallbladder should be pursued as much as possible, and whether to perform extended removal surgery should be decided according to the pathological results. It is generally believed that when the lesion involves the muscular layer of the gallbladder, extended debulking surgery should be performed, including resection of liver tissues near the gallbladder bed and soft tissues of the hepatoduodenal ligament and debulking of the lymph nodes draining the gallbladder area. For advanced gallbladder cancer, treatment should be analyzed on a case-by-case basis, including hemihepatectomy + hepatoduodenal ligament lymph node dissection and combined hepatopancreatoduodenectomy (HPD). Chemotherapy and radiotherapy can be used as postoperative adjuvant treatment for gallbladder cancer, but the effect is not very satisfactory. Features of our department: The diagnosis and treatment of middle and late stage gallbladder cancer is a major feature of our biliary and pancreatic surgery department, which is in an advanced position among many three hospitals in China. Through multidisciplinary discussion to formulate the most reasonable treatment plan, we have saved the lives of a number of patients with mid- to late-stage gallbladder cancer through combined liver resection, enlarged lymph node dissection and other expanded radical surgery for gallbladder cancer. A patient with gallbladder cancer who had a history of gallbladder stones for decades was diagnosed as having advanced gallbladder cancer, invading the liver, common bile duct, stomach and duodenum, etc. He was told by many tertiary hospitals in Shanghai that he was inoperable and finally came to our hospital. The patient was finally treated with HPD, and the right half of the liver, pancreatic head, duodenum, lower bile duct, gallbladder and distal stomach were removed, but the purpose of radical treatment was achieved.