From the Guidelines
A 4b/5 liver resection for gallbladder cancer is not recommended due to the advanced stage of the disease and potential for significant morbidity, with 5-year survival rates ranging from 5% to 10% 1.
Implications of Surgical Resection
- The goal of treatment shifts to palliative care and symptom management, rather than curative intent.
- Surgical resection may be considered in selected patients with resectable disease, but it is often associated with high morbidity and mortality rates.
- The presence of metastatic nodal disease, intrahepatic metastasis, or major vascular invasion are strong contraindications to surgical resection, with 5-year survival rates of less than 20% 1.
Alternative Treatment Options
- Chemotherapy with gemcitabine and cisplatin may be considered for patients with good performance status, as it has shown feasibility and potential survival benefit in biliary cancers 1.
- Radiation therapy may be used for local control of symptoms such as pain or bleeding.
- Supportive care measures, including pain management and management of biliary obstruction, should be implemented as needed to improve quality of life and manage symptoms.
Multidisciplinary Approach
- A multidisciplinary team approach is essential in the management of gallbladder cancer, involving surgeons, medical oncologists, radiation oncologists, and palliative care specialists.
- Patients with gallbladder cancer should be referred to high-volume hepatobiliary centers for optimal management and consideration of clinical trials 1.
From the Research
Implications of a 4b/5 Liver Resection for Gallbladder Cancer
The implications of a 4b/5 liver resection for gallbladder cancer are significant, as this procedure is often performed as part of an extended cholecystectomy to improve long-term prognosis in patients with T1b and beyond cancers 2, 3, 4.
- Surgical Strategy: A 4b/5 liver segmentectomy is a type of hepatic resection that may be required for patients with gallbladder cancer, particularly those with T1b, T2, and T3 tumors 5.
- Prognostic Factors: The prognosis of gallbladder cancer patients who undergo a 4b/5 liver resection depends on several factors, including the depth of parietal invasion, metastatic nodal disease, surgical margin status, and overall TNM-stage 5.
- Radical Resection: Radical resection, including 4b/5 liver segmentectomy, lymphadenectomy, and port-sites excision, may be necessary to obtain a radical excision of the tumor and accurate disease staging 5.
- Residual Disease: The presence of residual disease after re-resection is a significant prognostic factor, reducing median disease-free survival and disease-specific survival 5.
- Survival Outcomes: The overall and disease-free survival of patients with gallbladder cancer who undergo a 4b/5 liver resection vary depending on the stage of the disease, with significant differences in outcomes between patients with stages ≤ IIB and ≥ IIIA disease 6.
Surgical Management
Surgical management of gallbladder cancer, including 4b/5 liver resection, should be individualized based on the patient's disease stage, overall health, and other factors 3, 4, 6.
- Extended Cholecystectomy: Extended cholecystectomy, which includes hepatic resection, lymph node clearance, and other procedures, may be necessary to improve long-term prognosis in patients with T1b and beyond cancers 2, 3, 4.
- Lymph Node Dissection: Lymph node dissection, including intentional dissection of lymph nodes around the cystic duct, may help prevent metastases or recurrence in early-stage gallbladder cancer patients 6.
- Hepatectomy: Hepatectomy, including minor and major hepatectomies, may be performed to achieve negative bile duct margins and improve survival outcomes 6.