Radical cholecystectomy for gallbladder cancer [Introduction] The incidence of gallbladder cancer in China ranks 19th among malignant tumors and 6th among gastrointestinal malignant tumors, ranking first among biliary tract malignant tumors. Most cases of gallbladder cancer are found by pathological examination after gallbladder resection, and it is not common to have a clear diagnosis before surgery. In this case, the patient was diagnosed as gallbladder cancer invading the liver before surgery, and determining the appropriate treatment method will directly affect the prognosis. The patient was a 64-year-old female who was admitted to an external hospital for “coronary heart disease” and was found to have “gallbladder cancer with liver metastasis” by abdominal CT examination during treatment. After admission, there were no significant abnormalities in routine blood and biochemistry; CEA and CA199 were within normal range; no positive signs on physical examination. The patient’s liver lesion was considered to be a direct invasion of gallbladder cancer, which was relatively limited and could be completely resected without lymph node metastasis, abdominopelvic metastasis or distant metastasis. Considering the patient’s general condition, liver and kidney function and tumor status, we decided to perform radical surgery for gallbladder cancer and resect the gallbladder and invaded liver tissue at the same time. After open exploration, a 5×6 cm mass with hard texture and poorly defined borders could be palpated in the gallbladder area and V and IV segments of the liver. The hepatic round ligament was dissected and the hepatic sickle ligament was freed. The hepatoduodenal ligament was dissected, and the cystic duct and cystic artery were exposed and ligated, and the neck of the gallbladder was separated. Dissect the hepatic hilum, the first hepatic hilum to prepare the hilar blocking band. The lymph nodes in the hilar region are cleared. The hepatic sickle ligament and the right coronary ligament and right deltoid ligament are separated and the right liver is held anteriorly and inferiorly. An incision line is defined on the surface of the liver 2.0 cm from the tumor, and several traction lines are sutured along the predetermined incision line. The fibers and small vessels on the cut surface were cut by electrocoagulation, and larger vessels were cut by ligation. The right hepatic mass and some surrounding normal liver tissues as well as the gallbladder were completely removed. The cut edge of the gallbladder duct was sent to frozen section for pathological examination, and the results reported that no cancer cells were found. The patient recovered well after surgery and was discharged on the ninth day with stitches removed. Pathology and prognosis] The tumor section showed typical fish-like changes. Pathological findings: intermediate-to-low differentiated adenocarcinoma of the gallbladder with visible tumor plugs and involvement of liver tissue; fatty degeneration was seen in the surrounding liver. No cancer was seen in the cut edge of gallbladder and liver. There was no metastasis in the lymph nodes. The patient has been postoperative for nine months, and there is no sign of recurrence and metastasis on repeat CT. Case Discussion】 Surgery is the main treatment for gallbladder cancer, and if radical resection can be achieved, it will greatly improve the patient’s prognosis. In this case, the gallbladder cancer directly invaded the liver without lymph node metastasis, and the tumor stage was T3N0M0, which is a stage IIA case. According to previous reports, the five-year survival rate after radical resection can reach 15-63%. A clear diagnosis before surgery is a prerequisite for a reasonable treatment plan. For patients with preoperative suspicion of gallbladder cancer, they should be prepared for radical surgery and laparoscopic exploration is not recommended; the latter can increase the risk of gallbladder rupture, implantation metastasis, and will additionally increase the risk of perforation hole metastasis. Gallbladder rupture and bile outflow during surgery is a high risk factor for recurrent metastasis, especially implantation metastasis, and should be carefully dissected and strictly tumor-free intraoperatively. It is recommended to dissect and ligate the cystic duct firstly during surgery. For patients with pathological diagnosis of gallbladder cancer after simple cholecystectomy, whether to perform secondary surgery and the mode of secondary surgery will directly affect the prognosis. For patients with T1a stage, resection of gallbladder alone can achieve radical cure without reoperation. For patients with stage T1b, it is still controversial whether to perform reoperation, but considering the high malignancy and rapid progression of gallbladder cancer, most experts recommend reoperation. Therefore, some experts suggest that laparoscopic examination should be performed first to clarify the stage of the second surgery, and if there is no implantation metastasis, then the second surgery should be performed openly to avoid blindly opening the abdomen. The main purpose of secondary surgery is to obtain negative margins and to clear the lymph nodes in the porta hepatis. The margins include the margins of the involved liver and the bile ducts. When removing the involved liver, an anatomical hepatectomy is not required as in hepatocellular carcinoma surgery, as long as negative margins are achieved. In most cases, a 2-cm margin is sufficient. Intraoperative cryopathological examination of the bile duct margins is required. Contrary to some previous views, clinical studies have confirmed that routine resection of the common bile duct is not necessary as long as negative margins are achieved, which only increases surgical complications and mortality, with no significant improvement in survival. Radical surgery for gallbladder cancer involves complex anatomy in the hilar region and partial hepatectomy; and a large retrospective analysis of studies has confirmed that immediate radical surgery after intraoperative cryo-confirmation of gallbladder cancer has no prognostic impact compared to secondary surgery. Therefore, it is recommended to transfer to a specialist hospital or hepatobiliary surgery center for secondary radical surgery after pathological diagnosis.