ABSTRACT
A great deal of pessimism has traditionally been associated with the treatment of gallbladder cancer. There are many reasons for the general nihilism associated with this disease entity since its first description in 1778.1 Foremost is the aggressive nature for dissemination of this cancer. Gallbladder cancer spreads early by direct invasion into the liver, by lymphatic metastasis to regional nodes, by peritoneal dissemination to produce carcinomatosis, and by hematogenous means to produce discontiguous liver metastasis and other distant metastases. This cancer, therefore, often presents late when surgical excision is either no longer possible or technically difficult, and alternative therapies are generally ineffective. Therefore, it is not surprising that Blalock recommended in 1924 that surgery be avoided for gallbladder cancer if the diagnosis could be made preoperatively.2 In fact, until recently, the 5-year survival in most large series was less than 5%, and the median survival was less than 6 months.3,4 As liver resection has become increasingly safe, significant experience has demonstrated radical surgery to be a sensible option in treatment of this disease and the only potentially curative option.5,6 Surgical excision is the treatment option of choice for those patients whose gallbladder cancers are confined to the local region of the liver and porta hepatis.
