Major Resections for Gall Bladder Cancer

Extended cholecystectomy is the standard surgical procedure for gall bladder cancer (GBC), but very few patients with a preoperative diagnosis of GBC are suitable for it. Many patients with advanced GBC need more major resections. GBC patients with jaundice need CBD excision along with extended cholecystectomy and often require a major hepatectomy in the form of extended right hepatectomy (ERH). These patients require extensive invasive preoperative preparation in the form of preoperative biliary drainage and portal vein embolization. Morbidity of major hepatectomy for GBC is high and mortality is significant. Hepato-pancreatoduodenectomy (HPD) for GBC is debatable and its role is being questioned. Combined resection of adjacent organs (CRAO), e.g., colon and duodenum, is very frequently required to achieve R0 resection. Vascular, hepatic artery and portal vein, resection is not recommended for GBC.