title: Gallbladder cancer: expert consensus statement.
abstract: An American Hepato-Pancreato-Biliary Association (AHPBA)-sponsored consensus meeting of expert panellists was convened on 15 January 2014 to review current evidence on the management of gallbladder carcinoma in order to establish practice guidelines. In summary, within high incidence areas, the assessment of routine gallbladder specimens should include the microscopic evaluation of a minimum of three sections and the cystic duct margin; specimens with dysplasia or proven cancer should be extensively sampled. Provided the patient is medically fit for surgery, data support the resection of all gallbladder polyps of >1.0 cm in diameter and those with imaging evidence of vascular stalks. The minimum staging evaluation of patients with suspected or proven gallbladder cancer includes contrasted cross-sectional imaging and diagnostic laparoscopy. Adequate lymphadenectomy includes assessment of any suspicious regional nodes, evaluation of the aortocaval nodal basin, and a goal recovery of at least six nodes. Patients with confirmed metastases to N2 nodal stations do not benefit from radical resection and should receive systemic and/or palliative treatments. Primary resection of patients with early T-stage (T1b-2) disease should include en bloc resection of adjacent liver parenchyma. Patients with T1b, T2 or T3 disease that is incidentally identified in a cholecystectomy specimen should undergo re-resection unless this is contraindicated by advanced disease or poor performance status. Re-resection should include complete portal lymphadenectomy and bile duct resection only when needed to achieve a negative margin (R0) resection. Patients with preoperatively staged T3 or T4 N1 disease should be considered for clinical trials of neoadjuvant chemotherapy. Following R0 resection of T2-4 disease in N1 gallbladder cancer, patients should be considered for adjuvant systemic chemotherapy and/or chemoradiotherapy.
authors.affiliation: Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Aloia
authors.affiliation: Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Católica de Chile), Santiago, Chile.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Járufe
authors.affiliation: Department of GI Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Milind
authors.initials: M
authors.lastname: Javle
authors.affiliation: Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Shishir K
authors.initials: SK
authors.lastname: Maithel
authors.affiliation: Department of Digestive Surgery, School of Medicine, Catholic University of Chile (Pontificia Universidad Catolica de Chile), Santiago, Chile.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Roa
authors.affiliation: Department of Pathology and Laboratory Medicine, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: Volkan
authors.initials: V
authors.lastname: Adsay
authors.affiliation: Department of Abdominal Surgery, AC Camargo Cancer Centre, São Paulo, Brazil.
authors.forename: Felipe J F
authors.initials: FJ
authors.lastname: Coimbra
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D002763:Cholecystectomy / Q000379:methods; D032921:Consensus; D005706:Gallbladder Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D010166:Palliative Care / Q000706:statistics & numerical data; D018579:Patient Selection; D012307:Risk Factors; D017678:Sex Distribution; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology