Epidemiology and Risk Factors Gallbladder cancer is the most common biliary tract malignancy, with approximately 5,000 new cases in the United States this year. Age at diagnosis of gallbladder cancer is generally between 70-75 years, with more women than men in a ratio of 3:157-60. Worldwide, it is most commonly seen in Israeli, Mexican, Chilean, Japanese, and Turkish American women, especially in New Mexico. Gallstones are the most important high-risk predisposing factor for gallbladder cancer, especially in patients with concomitant cholecystitis. Other risk factors include calcification of the gallbladder (porcelain gallbladder), gallbladder polyps, carriers of typhoid fever, and exposure to carcinogens (e.g., nitrogen mustard, nitrosamines). Unfortunately, most diagnosed cases of gallbladder cancer are too advanced for surgery. Its clinical manifestations are usually nonspecific, such as abdominal pain, weight loss, decreased appetite, nausea, acute cholecystitis, and jaundice. Nearly 20% of resectable patients are diagnosed by chance. There are no specific laboratory tests or markers to aid in the diagnosis. Further investigations including CT or MRI, liver function, chest radiograph and laparoscopy for disease staging should be performed in patients with suspicious masses detected by ultrasound. If there is no distant metastasis, laparoscopy can also be used as a means of surgical treatment, and if polyp-like lesions are found on ultrasound, cholecystectomy should be considered before radical treatment of gallbladder cancer. For patients with jaundice, further adjuvant examinations such as ERCP (endoscopic retrograde cholangiopancreatography), PTC (percutaneous hepatic cholangiography) or MRP (magnetic resonance cholangiography) should be performed. For patients with incidental intraoperative findings of gallbladder cancer that can be surgically resected, cholecystectomy, whole liver resection and lymph node dissection are feasible, and bile duct resection is optional. This method can improve the survival rate. For patients with jaundice or masses detected by ultrasound, the above surgical approach is also applicable under the condition that the lesion is resectable as determined by the adjuvant examination. For patients with masses detected on imaging, further CT or MRI, liver function tests, chest radiographs, surgical consultation, and evaluation of residual liver function should be performed. For patients with associated jaundice, further CT or MRI, liver function tests, chest radiographs, surgical consultation, and ERCP (endoscopic retrograde cholangiopancreatography)/PTC (percutaneous hepatic cholangiography)/MRC (magnetic resonance cholangiopancreatography) should be performed. For patients with postoperative pathologically confirmed stage T1a, if the incisional margin is negative (gallbladder is completely removed), they can be followed up only; if the gallbladder is not completely removed, a repeat procedure is required. For patients with stage T1b or more advanced, surgical resection should be considered after CT/MRI and chest radiographs confirm the absence of distant metastases. For all patients who can be surgically resected, the liver lobes should be removed and lymph node dissection should be performed, and bile duct resection is optional. In addition, the hilum should be resected in patients undergoing laparoscopic surgery, as this area is prone to recurrence after surgery. Postoperative chemotherapy and radiotherapy based on the 5-FU regimen should be administered to all patients except those with T1, N0 stage. The results of a small trial showed that 5-year survival rates in patients after complete resection were improved with the combination of 5-FU chemotherapy and radiotherapy (64% and 33%, respectively).62 Unfortunately, due to the relatively small number of gallbladder cancer cases, only one randomized clinical phase III trial has evaluated the impact of adjuvant therapy on survival after surgery for gallbladder cancer. For patients with unresectable tumors, no significant distant metastases, and no jaundice, 5-FU regimen-based chemotherapy combined with radiotherapy may be chosen as adjuvant therapy. Despite this, the overall survival rate of patients remains low. As no treatment has been found to significantly improve overall survival, supportive therapies or clinical trials may be considered for patients who cannot be surgically resected. Results from a recent small trial (8 patients) showed that oral capecitabine was effective against inoperable gallbladder cancer; two patients had a complete effect and half had some effect. The mean survival time of patients was 9.9 months65. In patients with jaundice and inoperable preoperative evaluation, biopsy should be considered to clarify the diagnosis. Such patients may be considered for biliary decompression as a de novo treatment before the initiation of chemotherapy (gemcitabine and/or 5-FU regimen-based chemotherapy). Clinical trials and supportive care approaches may also be considered. Biliary decompression combined with chemotherapy can be effective in improving the quality of life of patients.