Although the incidence rate of gallbladder cancer is much lower than that of liver cancer and pancreatic cancer, the prognosis of gallbladder cancer is comparable to or even worse than these two types of cancer, because patients with gallbladder cancer are often accompanied by gallstones and chronic cholecystitis, which are easily confused with these diseases in the early stage and are often diagnosed at an advanced stage; moreover, because of its low incidence rate, clinicians themselves often do not pay enough attention to it and know less about standardized treatment. Besides the stage of the disease, is the prognosis of gallbladder cancer closely related to the effective and standardized treatment? Today, we will give you an in-depth explanation. Some data of gallbladder cancer Incidence of gallbladder cancer? What is the prognosis? Etiology? The incidence rate of gallbladder cancer is about 2.5/100,000 in the United States, and there is no particularly accurate data in China. The prognosis of gallbladder cancer is very poor, with a median survival of about 10 months, and the predisposing factors are mainly gallstones, chronic cholecystitis, gallbladder polyp-like lesions, abnormal biliopancreatic duct confluence, etc. Gallbladder cancer and laparoscopy Do patients with gallbladder cancer need to undergo routine laparoscopic exploration before surgery? Preoperative laparoscopy is not recommended for gallbladder cancer because the positive detection rate is low, but for stage T3 gallbladder cancer, laparoscopy may help to change the treatment plan. Surgical treatment of gallbladder cancer How to make surgical decision for patients with resectable tumor on open exploration but have developed peri-abdominal trunk and para-abdominal aortic lymph node metastasis? Is palliative resection or extensive lymph node dissection performed? Patients with peri-abdominal trunk and para-aortic lymph node metastases should be considered as IVb, and the prognosis is very poor, so surgical resection is not recommended. In fact, these metastases should be detected preoperatively by imaging, while avoiding patients to undergo the pain of open surgery. What is the value of liver transplantation in the surgical treatment of gallbladder cancer? The vast majority of patients with gallbladder cancer have a history of gallstones or chronic cholecystitis. Gallbladder polyps are also a high risk factor for gallbladder cancer, but less so compared to stones. What is the scope of radical surgery for lower gallbladder cancer? Which groups of lymph nodes need to be cleared? Is further chemotherapy necessary after surgery? Stage T1a gallbladder cancer can be treated by simple cholecystectomy, while the standard radical surgery for T1b and above stages of gallbladder cancer includes resection of gallbladder + IVB+V segment of liver and lymphatic clearance in the hilar region, so the scope of lymphatic clearance is not recommended to be expanded blindly, and only patients with T1a and T1bN0 do not need postoperative adjuvant chemotherapy after surgery, while other stages are recommended to have postoperative adjuvant chemotherapy. What is the scope of resection of gallbladder cancer found intraoperatively? How to deal with gallbladder cancer found after surgery? Chemotherapy plan? It depends on the T-stage of gallbladder cancer, T1a stage gallbladder cancer can be treated by simple cholecystectomy, T1b stage and above standard radical gallbladder cancer surgery includes gallbladder + liver IVB+V segment resection and lymphatic clearance in the hilar region. In case of accidental gallbladder cancer, pathological return of T1a stage gallbladder cancer can be treated by simple cholecystectomy, while T1b and above stage still need secondary surgery, and the scope of secondary surgery should include IVB+V segment resection of liver and lymphatic clearance of hepatoportal area. In case of R0 resection, postoperative adjuvant chemotherapy is recommended to give gemcitabine or fluorouracil-based chemotherapeutic agents as single-drug regimen; in case of R1 resection, radiotherapy can be added on top of the above regimen; in case of R2 resection, combined regimen such as gemcitabine combined with cisplatin is recommended. What are the specific aspects of standardized treatment? For example, in T1b gallbladder cancer, simple cholecystectomy is not enough, but in clinical practice, we see many patients with accidental gallbladder cancer, who often underwent surgical removal of gallbladder because of gallstones or cholecystitis and were found to have gallbladder cancer after surgery, and T1b or even T2, were not recommended to continue surgery, or patients with lymph node metastasis were found after surgery. The patients were also not recommended to undergo postoperative adjuvant chemoradiotherapy. Gallbladder cancer and gallbladder polyps Do all patients with gallbladder cancer have to experience gallstones or gallbladder polyps in order to get gallbladder cancer? The vast majority of gallbladder cancer patients will have a history of gallstones or chronic cholecystitis. Gallbladder polyps are also a high risk factor for gallbladder cancer, but less so compared to stones. Do all these people who have gallbladder cancer have to experience gallstones or gallbladder polyps before they can get gallbladder cancer? If gallbladder polyps or gallstones are detected during medical checkups, is it possible to avoid gallbladder cancer by having the gallbladder cut directly? In fact, gallbladder cancer is most common in middle-aged and elderly people. If the patient is relatively young, the stones are not serious and the polyps are less than 1cm, it is still recommended to observe, after all, the gallbladder has its own physiological function, and preventive removal of gallbladder is not recommended for these patients. In fact, there are ways to control gallbladder cancer in its early stage, but in the middle and late stages, the malignancy is relatively high and the mortality rate is also higher. Systemic chemotherapy is still the first choice for advanced gallbladder cancer, but individualized treatment plans should be formulated through MDT team discussions. For intermediate stage gallbladder cancer, radical surgery combined with postoperative adjuvant chemotherapy or chemoradiotherapy is recommended to prolong the survival of patients. The prognosis of gallbladder cancer is very poor, how can we improve the early diagnosis rate? Gallbladder cancer is usually found in middle-aged and elderly women, and patients with previous gallstones, especially those larger than 2cm or filled stones, long history of chronic cholecystitis, significant thickening of the gallbladder wall, gallbladder atrophy, or polyp-like changes of more than 1cm, are recommended to have close review and preventive removal of gallbladder if necessary.