Gall Bladder Cancer with Jaundice: The Unscaled Frontier

  • Anu Behari
  • V. K. Kapoor
Part of the GI Surgery Annual book series (GISA, volume 24)


Gallbladder cancer (GBC), the most common malignancy of the biliary tract, continues to be a challenge. Complete surgical resection, whenever possible, remains the best chance of cure. Surgical obstructive jaundice (SOJ) in GBC is well known as an important predictor of poor prognosis [1–3]. It is associated with several unfavourable anatomical, physiological and pathological features which together translate into poor chances of a curative surgical resection and an overall poor prognosis. This is reflected in the literature as the absence of a large series of curative resections in patients with GBC and SOJ. We address the anatomical and pathological basis, role, efficacy and results of surgical resection in patients with GBC and SOJ; palliation (surgical or non-surgical) of SOJ is not being addressed.


  1. 1.
    Hawkins WG, DeMatteo RP, Jarnagin WR, Ben-Porat L, Blumgart LH, Fong Y. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. 2004;11:310–5.CrossRefGoogle Scholar
  2. 2.
    Miyazaki M, Itoh H, Ambiru S, Shimizu H, Togawa A, Gohchi E, et al. Radical surgery for advanced gallbladder carcinoma. Br J Surg. 1996;83:478–81.CrossRefGoogle Scholar
  3. 3.
    Kaneoka Y, Yamaguchi A, Isogai M, Harada T, Suzuki M. Hepatoduodenal ligament invasion by gallbladder carcinoma: histologic patterns and surgical recommendation. World J Surg. 2003;27:260–5.CrossRefGoogle Scholar
  4. 4.
    Feng FL, Liu C, Li B, Zhang BH, Jiang XQ. Role of radical resection in patients with gallbladder carcinoma and jaundice. Chin Med J. 2012;125:752–6.PubMedGoogle Scholar
  5. 5.
    Nishio H, Ebata T, Yokoyama Y, Igami T, Sugawara G, Nagino M. Gallbladder cancer involving the extrahepatic bile duct is worthy of resection. Ann Surg. 2011;253:953–60.CrossRefGoogle Scholar
  6. 6.
    Shimizu Y, Ohtsuka M, Ito H, Kimura F, Shimizu H, Togawa A, et al. Should the extrahepatic bile duct be resected for locally advanced gallbladder cancer? Surgery. 2004;136:1012–7.CrossRefGoogle Scholar
  7. 7.
    Shimada H, Endo I, Fujii Y, Kamiya N, Masunari H, Kunihiro O, et al. Appraisal of surgical resection of gallbladder cancer with special reference to lymph node dissection. Langenbeck's Arch Surg. 2000;385:509–14.CrossRefGoogle Scholar
  8. 8.
    Yang XW, Yuan JM, Chen JY, Yang J, Gao QG, Yan XZ, et al. The prognostic importance of jaundice in surgical resection with curative intent for gallbladder cancer. BMC Cancer. 2014;14:652.CrossRefGoogle Scholar
  9. 9.
    Regimbeau JM, Fuks D, Bachellier P, Le Treut YP, Pruvot FR, Navarro F, et al. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. Eur J Surg Oncol. 2011;37:505–12.CrossRefGoogle Scholar
  10. 10.
    Mishra PK, Saluja SS, Prithiviraj N, Varshney V, Goel N, Patil N. Predictors of curative resection and long term survival of gallbladder cancer––a retrospective analysis. Am J Surg. 2017;214:278–86.CrossRefGoogle Scholar
  11. 11.
    Agarwal AK, Mandal S, Singh S, Bhojwani R, Sakhuja P, Uppal R. Biliary obstruction in gall bladder cancer is not sine qua non of inoperability. Ann Surg Oncol. 2007;14:2831–7.CrossRefGoogle Scholar
  12. 12.
    Kawarada Y, Isaji S, Taoka H, Tabata M, Das BC, Yokoi H. S4a + S5 with caudate lobe (S1) resection using the Taj Mahal liver parenchymal resection for carcinoma of the biliary tract. J Gastrointest Surg. 1999;3:369–73.CrossRefGoogle Scholar
  13. 13.
    Narita M, Matsusue R, Hata H, Yamaguchi T, Otani T, Ikai I. Liver parenchymal sparing surgery for locally advanced gallbladder cancer with extracapsular lymph node invasion. World J Surg Oncol. 2014;12:183.CrossRefGoogle Scholar
  14. 14.
    Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K. Extensive surgery for carcinoma of the gallbladder. Br J Surg. 2002;89:179–84.CrossRefGoogle Scholar
  15. 15.
    Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K, et al. Factors influencing postoperative hospital mortality and long-term survival after radical resection for stage IV gallbladder carcinoma. World J Surg. 2003;27:272–7.CrossRefGoogle Scholar
  16. 16.
    Chijiiwa K, Kai M, Nagano M, Hiyoshi M, Ohuchida J, Kondo K. Outcome of radical surgery for stage IV gallbladder carcinoma. J Hepato-Biliary-Pancreat Surg. 2007;14:345–50.CrossRefGoogle Scholar
  17. 17.
    Shimada K, Nara S, Esaki M, Sakamoto Y, Kosuge T, Hiraoka N. Extended right hemihepatectomy for gallbladder carcinoma involving the hepatic hilum. Br J Surg. 2011;98:117–23.CrossRefGoogle Scholar
  18. 18.
    Cherqui D, Benoist S, Malassagne B, Humeres R, Rodriguez V, Fagniez PL. Major liver resection for carcinoma in jaundiced patients without preoperative biliary drainage. Arch Surg. 2000;135:302–8.CrossRefGoogle Scholar
  19. 19.
    Nagino M, Kamiya J, Nishio H, Ebata T, Arai T, Nimura Y. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg. 2006;243:364–72.CrossRefGoogle Scholar
  20. 20.
    Sharma A, Behari A, Sikora SS, Kumar A, Saxena R, Kapoor VK. Post-cholecystectomy biliary strictures: not always benign. J Gastroenterol Hepatol. 2008;23(7 Pt 2):e63–6.CrossRefGoogle Scholar
  21. 21.
    Agrawal S, Sonawane RN, Behari A, Kumar A, Sikora SS, Saxena R, et al. Laparoscopic staging in gallbladder cancer. Dig Surg. 2005;22:440–5.CrossRefGoogle Scholar
  22. 22.
    Ebata T, Yokoyama Y, Igami T, Sugawara G, Takahashi Y, Nagino M. Portal vein embolization before extended hepatectomy for biliary cancer: current technique and review of 494 consecutive embolizations. Dig Surg. 2012;29:23–9.CrossRefGoogle Scholar
  23. 23.
    D’Angelica M, Dalal KM, DeMatteo RP, Fong Y, Blumgart LH, Jarnagin WR. Analysis of the extent of resection for adenocarcinoma of the gallbladder. Ann Surg Oncol. 2009;16:806–16.CrossRefGoogle Scholar
  24. 24.
    Saluja SS, Gulati M, Garg PK, Pal H, Pal S, Sahni P, et al. Endoscopic or percutaneous biliary drainage for gallbladder cancer: a randomized trial and quality of life assessment. Clin Gastroenterol Hepatol. 2008;6:944–50.e3.CrossRefGoogle Scholar
  25. 25.
    Tran T, Ethan CGM, Powlik TM, et al. Gall bladder cancer presenting with jaundice: uniformly fatal or still potentially curable? J Clin Oncol. 2016;34:336.CrossRefGoogle Scholar

Copyright information

© Indian Association of Surgical Gastroenterology 2018

Authors and Affiliations

  • Anu Behari
    • 1
  • V. K. Kapoor
    • 1
  1. 1.Department of Surgical GastroenterologySanjay Gandhi Post Graduate Institute of Medical SciencesLucknowIndia

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