A few days ago, a young nurse from our hospital came to me with a copy of her own ultrasound report and worriedly ? asked whether a 0.9 cm, solitary gallbladder polyp that appeared on her gallbladder would be cancerous. In this regard, I think it is necessary to introduce the new viewpoints on the current management related to gallbladder cancer. Clinically, there are people who are worried about gallbladder cancer because of stones and polyps, people who are obviously at high risk but missed screening, and people who have incidentally discovered gallbladder cancer but not completely removed. With the advancement of related research, we have been able to provide better assistance. Gallbladder cancer is a very aggressive malignant tumor with the characteristics of early lymph node metastasis, direct infiltration of liver tissue, and susceptibility to abdominal implantation and hematogenous metastasis. Its mortality rate is very high, with a 5-year survival rate of 5% and an average survival period of 5-8 months. It is the true king of cancers because of its poor long-term outcome compared with liver cancer and pancreatic cancer. High risk factors include: elderly women, large stones, adenomatous polyps. The etiology of primary gallbladder cancer is not yet known. However, it has become a consensus that cholecystitis, cholelithiasis, bacterial infection, disturbance of bile acid metabolism and gallbladder mucosal hyperplasia are related to the occurrence of gallbladder cancer. In addition, high-fat diet, smoking and alcoholism are also risk factors for the occurrence of gallbladder cancer. The ratio of male to female incidence of gallbladder cancer is 1:2.7, and the average age of incidence is 65.2 years. In early stage, there are often no specific symptoms, and when found, it is mostly in advanced stage, and only those who can be surgically removed can have a longer survival. According to domestic statistics, 31.6% of gallbladder cancer patients have gallbladder stones at the same time; the occurrence of gallbladder cancer is closely related to the size of stones, and the incidence of gallbladder cancer is 1.0% for stones of 10mm in diameter; 2.4% for stones of 20-22mm in diameter; 10% for stones of >30mm in diameter. Gallbladder polyps are divided into cholesterol polyps and adenomatous polyps. If adenomatous polyps are single, broad-based polyps with a diameter of >1 cm, the chance of malignant transformation will be greatly increased. Foreign studies have shown that there may be a pathogenetic sequence between benign polyps of the gallbladder, gallbladder adenoma and gallbladder cancer, and it usually takes 3 to 10 years for atypical hyperplasia to develop into cancer. Cholesterol polyps, on the other hand, are not cancerous, so when you encounter this type of patients, you can let him relax. In conclusion, clinically, when encountering middle-aged or older women over 60 years old with filled gallstones or gallbladder polyps over 1 cm or porcelain gallbladder, extra emphasis needs to be placed on regular close review or even preventive gallbladder removal. If the patient undergoes surgery for stones or polyps, an intraoperative rapid pathological examination needs to be sent to avoid a postoperative diagnosis of cancer and a second surgery. The diagnostic combination should include: tumor markers + ultrasound + MRI. The measurement of tumor markers provides a lot of help for gallbladder cancer diagnosis. For example, when serum carcinoembryonic antigen (CEA) >4ng/ml, the specificity of diagnosing gallbladder cancer with clinical manifestations is 93% and the sensitivity is 50%; the sensitivity of CA199 serum level >20U/ml is 79.2% and the specificity is 89.2%. However, the test may not be elevated in early cancerous cases, or when combined with other gastrointestinal diseases and certain tumors, false-positive results may occur, so it must be combined with imaging tests. Ultrasound is the easiest and most reliable way to show the gallbladder. Ultrasound has an accuracy rate of more than 90% and is the first choice for gallbladder disease diagnosis. With the continuous replacement of instruments, it is now possible to clearly observe not only the size of gallbladder lesions, but also the blood flow of the lesions to determine whether cancer has occurred, and to observe whether there are obvious lymph node metastases and whether the liver is involved, and experienced examiners can even determine which layer of the gallbladder is involved in the lesions. MRI has become an ideal tool for detecting gallbladder cancer because of its good tissue contrast and multilevel imaging characteristics, and it can detect thickening of the gallbladder wall, infiltration of the liver parenchyma, and metastatic enlargement of the surrounding lymph nodes. The scope of surgery for stage T1b gallbladder cancer includes: cholecystectomy + hepatic segment IV and V resection + lymph node dissection. Gallbladder cancer has no characteristic manifestation in early stage and is difficult to distinguish from chronic cholecystitis, so patients will mostly have their first consultation in general hospitals. Many gallbladder cancers are found incidentally after cholecystectomy due to gallstones or cholecystitis or after laparoscopic cholecystectomy. Complete removal of the tumor may be the only means of curing gallbladder cancer. The surgical treatment of gallbladder cancer varies greatly in different cases, and the prognosis of patients is significantly different. The clinical stage of gallbladder cancer is a decisive factor in the scope of surgical resection and prognosis of gallbladder cancer. Stage T1a gallbladder cancer only invades the mucosa or lamina propria of the gallbladder. Since there is almost no lymph node metastasis in this stage, gallbladder cancer can be cured by simple cholecystectomy, so there is no need for secondary surgery. Numerous studies have confirmed that for patients with pathologically confirmed stage T1a gallbladder cancer, the 5-year survival rate of cholecystectomy alone is 100%, provided that negative cystic duct margins are ensured. Recent studies have focused on stage T1b, i.e., can the gallbladder be resected alone when the gallbladder cancer invades the muscular layer? Previously, it was believed that the muscular layer was still localized to the gallbladder, and thus there were many people who performed simple resection of the gallbladder in stage T1b. However, several recent evidence-based medical evidence does not support this view. At last year’s World Congress on Hepatobiliary and Pancreatic Diseases, colleagues from the United States comparatively studied the outcomes of nearly 1,000 patients with T1b gallbladder cancer and showed that patients who had their gallbladder removed alone had worse survival and recurrence rates than those treated with standard radical surgery. The 5-year survival rate of radical resection was 70% to 90%, while the 5-year survival rate of cholecystectomy alone was 40% to 50%. Therefore, stage T1b gallbladder cancer, like T2 gallbladder cancer, should be treated with cholecystectomy + hepatic segment IV and V resection + regional lymph node dissection. For these patients, radical resection is the best method. According to the above management principles, I gave this nurse, perfected the appropriate tests and performed laparoscopic surgical history, and the postoperative pathology report was gallbladder adenoma polyp with very satisfactory results.