Principles of surgical treatment for gallbladder cancer 1. Radical surgery for occult gallbladder cancer Occult gallbladder cancer refers to those who have not been diagnosed before and during surgery, but are diagnosed as gallbladder cancer by pathological section after cholecystectomy due to “benign” diseases, so the problem is whether to perform radical surgery again. If the postoperative pathological section reveals that the cancer only invades to the mucosal layer or muscle layer, complete cholecystectomy alone can achieve the purpose of radical treatment, so a second radical surgery is not necessary. The lymphatic metastasis of gallbladder cancer first involves the gallbladder triangle and the lymph nodes along the common bile duct, and the lymph nodes located in the gallbladder neck, especially those in the gallbladder duct, because of their location near the gallbladder triangle. The postoperative recurrence rate of gallbladder neck carcinoma is also significantly higher than that of carcinoma at the base of the gallbladder body. Therefore, for occult gallbladder cancer located in the gallbladder neck and gallbladder duct, lymph node dissection around the hepatoduodenal ligament should be performed again regardless of which layer of the gallbladder wall it has invaded. For occult gallbladder cancer with infiltration depth exceeding the muscle layer, positive margins and positive gallbladder triangle lymph node biopsy, a second radical surgery should also be performed. Overall, the median survival of gallbladder cancer patients is 3 months, so some surgeons are pessimistic about the treatment of gallbladder cancer. In recent years, due to the development of radical surgery for gallbladder cancer, the 5-year survival rate after surgery has been significantly improved. The scope of radical surgery mainly includes cholecystectomy, partial hepatectomy and lymph node dissection of the liver, which is usually about 3 cm around the gallbladder bed. Lymph node dissection depends on the route of confluence and metastasis. Generally, the lymph nodes should be cleared to the next station of metastatic lymph nodes in early stage gallbladder cancer, but most resectable gallbladder cancers should be cleared to the lymph nodes of hepatoduodenal ligament, and if necessary, the lymph nodes behind the pancreatic head on the pancreatic duodenum should be cleared. 3.Palliative surgery for advanced gallbladder cancer: For advanced gallbladder cancer cases that cannot be cured, the principle of surgery is to reduce pain and improve life quality. The more prominent problem of advanced gallbladder cancer is the obstructive yellow bile caused by the cancer invading the biliary system, and internal drainage should be considered as much as possible. Internal drainage methods include bile duct-jejunostomy, etc. However, due to the deep infiltration of local cancer, especially those with hepatoportal infiltration, bile-intestinal internal drainage is often not easy to perform. For such patients, internal drainage by bridging is feasible. For patients with very poor general condition, external drainage can also be performed. For patients with severe invasion of the hilum, the right liver can be incised by scraping and aspiration to find the dilated hepatic ducts in the right liver for drainage. Radiation therapy: It is only used as an adjuvant for cases after surgery or when resection is impossible, Todoroki reported that the 3-year survival rate of gallbladder cancer lesions resected with radiation therapy is 10.1%, while that of those without radiation therapy is 0. The general radiation dose is 40-50 GY intraoperative radiation, that is, after resection of the lesion, the electron beam generated by cyclotron is used to give 20-30 GY of radiation. It is difficult to observe the efficacy of chemotherapeutic drugs, so it is mostly used for postoperative adjuvant treatment. The commonly used drugs are ADM, 5-FU, MMC, etc. (VI) Prognosis
The 5-year survival rate of gallbladder cancer is very low, about 2%-5%; more than 80% of patients can die within 1 year. If the gallbladder cancer only invades the mucosa and submucosa layer, the prognosis of cholecystectomy is better. Some people reported that the 5-year survival rate of this group of patients can reach 40%-64%. Therefore, the key to good prognosis is early diagnosis and timely treatment. Treatment principles of gallbladder cancer Gallbladder cancer is a malignant tumor occurring in the gallbladder, mostly seen in women. The cause of cholangiocarcinoma is still not clear, because 60-90% of cholangiocarcinoma is accompanied by gallbladder stones, and some people believe that long-term chronic stimulation of stones and damage of gallbladder mucosa may be the main cause. With the improvement of medical level, the treatment status of gallbladder cancer has been significantly improved compared with the past. 1. Treatment methods of gallbladder cancer Generally speaking, the most effective treatment method for early stage gallbladder cancer is surgical resection of gallbladder cancer because the cancer is small and has not spread and metastasized. Cholecystectomy is the main surgical method for early-stage gallbladder cancer, and the 5-year survival rate of gallbladder cancer patients after surgical resection can reach more than 60%. Clinically, the treatment methods for middle and late stage gallbladder cancer mainly include palliative surgery, radiotherapy and Chinese medicine treatment, each of which has its own advantages and disadvantages. For the middle and late stage gallbladder cancer with greater spread and multiple metastases, palliative surgery can be performed to reduce symptoms and improve life quality. If there is obstructive jaundice, bile duct drainage should be performed to reduce jaundice and skin itching; if there is pyloric obstruction, gastrojejunostomy can be performed, etc. Gallbladder cancer is more sensitive to radiotherapy, so radiotherapy is a common treatment for gallbladder cancer in the middle and late stages, which has direct killing effect on cancer, but also causes harm to normal cells. In addition, chemotherapy also has an inhibitory effect on cancer and can be combined with radiotherapy in the treatment of middle and late stage gallbladder cancer, which is more effective than radiotherapy or chemotherapy alone. In view of the toxic side effects of radiotherapy on human body, Chinese medicine can be combined with radiotherapy in the treatment of middle and late stage gallbladder cancer to enhance the effect and reduce the toxicity. For patients with extensive metastasis and weak body function, who can hardly tolerate chemotherapy, Chinese medicine can be used for conservative treatment. Although the short-term effect is not as obvious as chemotherapy, the long-term effect is good, and it has obvious effects in improving the quality of survival and prolonging the survival period. 2. Prognosis and nursing of gallbladder cancer treatment status Because early diagnosis of gallbladder cancer is not easy, therefore, the prognosis is poor. Proper daily nursing after treatment can play a role in preventing recurrence and improving resistance to disease. In terms of diet, patients with gallbladder cancer should eat fresh vegetables, eggs and steamed fish, avoid frying, deep-frying and high-fat foods, and should not consume red dates, cinnamon, white fungus and other tonic products that can cause abdominal distension. They should not consume red dates, cinnamon, white fungus and other tonic products that may cause abdominal distension.