Treatment of gallbladder cancer.
Treatment of gallbladder cancer includes 1 surgical resection, 2 radiotherapy, 3 chemotherapy, and other adjuvant treatments. Among them, the most important one with the best quality of survival and the longest survival time is surgery, which is also the only treatment that can bring the possibility of long-term survival.
The treatment of gallbladder cancer needs to decide the surgical plan according to the early or late development of gallbladder cancer, or according to the extent of gallbladder cancer invasion and invasion mode. For professional hepatobiliary, pancreatic and spleen surgeons, such staging is far from enough, and we need to know more specific depth and extent of invasion before deciding on the treatment plan.
Determination of early stage gallbladder cancer.
Ultrasound endoscopy has certain advantages in judging the invasion level of early gallbladder cancer, but it requires certain conditions and considerable experience in operation to distinguish whether the gallbladder cancer has invaded the mucosal layer of the gallbladder wall? The intrinsic muscular layer? Or the plasma membrane layer? This is of great reference value in deciding the surgical approach for early-stage gallbladder cancer, especially for patients with other combined diseases that are not suitable for extended surgery, or for patients who are not easily operated for a longer period of time, or who have higher risks or are of advanced age.
Judgment of progressive gallbladder cancer.
1. Types of progression of progressive gallbladder cancer.
(1) Gallbladder cancer with liver invasion, which has a very different prognosis from intrahepatic metastasis in non-adjacent liver. This type of gallbladder cancer has low incidence of obstructive jaundice, no specific manifestations, and the tumor is often already large when it is found late and visited, sometimes invading the colon, duodenum and other organs.
(2) Hilar invasive type, because of infiltration of the hilar structures, early onset of jaundice and smaller tumors.
(3) bile duct confluence invasive type, where the tumor grows locally and can cause obstructive jaundice, with early obstruction of the bile duct and significant gallbladder enlargement, sometimes not easily distinguished from common bile duct cancer.
(4) Lymph node metastasis type of gallbladder cancer, in this type, the gallbladder cancer still stays in the gallbladder, but the distant lymph nodes have obviously enlarged and metastasized, sometimes similar to jumping metastasis.
2.Whether there is metastasis of distant organs, such as lung metastasis, etc.
Intrahepatic metastasis in non-adjacent liver, if there is, most patients will not survive longer than one year.
3. Presence of multiple implant metastases in the abdominal cavity.
If there are, radical resection cannot be done, and it is not easy to determine before surgery. If suspected, the specific plan can be decided after exploring through laparoscopy to reduce the trauma of the patient.
Surgical treatment.
It mainly refers to the complete surgical removal of gallbladder cancer tissues and the adjacent organs and metastatic lymph nodes infiltrated by gallbladder cancer according to the above invasion scope and degree.
There are various types of surgery.
Simple cholecystectomy, palliative cholecystectomy, radical cholecystectomy, and extended radical cholecystectomy.
Simple cholecystectomy: theoretically suitable for patients with in situ cancer, or localized cancer of gallbladder adenoma, this surgical procedure is less invasive, but the resection area is obviously insufficient for progressive gallbladder cancer.
Palliative resection: For patients with distant metastasis or abdominal implantation and painful jaundice, it is necessary to solve the symptoms and cannot be completely and totally cured, so only palliative local resection is possible.
Radical resection and extended resection: generally according to the need to remove the liver around the gallbladder, the gallbladder, and clear group 12, group 8, group 13, and even more distant lymph nodes.
The specific surgical approach is determined by the type of invasion:
(1) Gallbladder cancer with hepatic infiltration, because the venous return part of the gallbladder flows directly back into the liver, so for this type a standardized partial resection of the liver is needed, and if it infiltrates the colon, duodenum, and other organs, a combined resection is needed.
(2) In the hilar invasive type, the common bile duct and common hepatic duct need to be resected together, so a choledo-intestinal anastomosis is required, and then depending on the depth of tumor infiltration in the bile duct, a combined hemihepatectomy and caudate lobe resection is required.
(3) Hepatocellular infiltration in the hepatoportal and hepatopancreaticoduodenal ducts, combined with hepatic resection and reconstruction of portal vein and hepatic artery are required.
(4) The biliary duct confluence infiltration type, which requires extrahepatic bile duct resection and biliary jejunostomy.
(5) Lymph node metastasis type of gallbladder cancer requires combined partial hepatectomy and clearance of lymph nodes in the hepatoduodenal ligament, around the pancreas, and adjacent to the abdominal aorta.
Radiotherapy, chemotherapy and targeted therapy are effective for gallbladder cancer, and Chinese herbal medicine can also relieve symptoms and improve quality of life, and biological therapy is also in clinical practice. At present, the efficiency of chemotherapy sensitivity for hepatobiliary and pancreatic tumors is less than that for gastrointestinal, gynecological and respiratory tract tumors. Therefore, the correct surgical resection plan becomes more important. The correct surgical plan is based on precise judgment, and this knowledge is a test for general surgeons and even surgeons specializing in hepatobiliary-pancreatic-splenic. It is the lifelong pursuit of every surgeon to decide on the appropriate treatment to expand or reduce the surgical plan according to the specific situation, thus giving the patient a chance of long-term survival or reducing trauma and pain.