From the Guidelines
The recommended treatment for T3N0M0 gallbladder cancer is surgical resection followed by adjuvant chemotherapy.
Surgical Approach
- Extended cholecystectomy with en bloc liver resection (segments IVb and V)
- Regional lymphadenectomy
- Possible bile duct excision if tumor is close to or involving the cystic duct
Adjuvant Chemotherapy
- Gemcitabine plus cisplatin for 6 cycles
- Typical regimen: Gemcitabine 1000 mg/m2 on days 1 and 8, plus cisplatin 25 mg/m2 on days 1 and 8, every 21 days Treatment should begin within 8-12 weeks after surgery, once the patient has adequately recovered. Close monitoring for side effects and dose adjustments may be necessary. This approach is recommended because T3 tumors have invaded the serosa or adjacent organs, but there's no lymph node involvement (N0) or distant metastasis (M0) 1. Surgery aims to remove all visible tumor, while adjuvant chemotherapy targets potential microscopic disease to reduce recurrence risk. The gemcitabine-cisplatin combination has shown improved survival outcomes in biliary tract cancers compared to other regimens. Some key points to consider:
- Patient selection for surgery is facilitated by careful preoperative staging, which may include surgical exploration and laparoscopy to identify patients with unresectable or metastatic disease 1.
- Biliary drainage should be considered before surgery, although controversy exists about the risks and benefits of this approach 1.
- Postoperative treatment after noncurative resection of cholangiocarcinoma remains controversial, and both supportive care and palliative chemotherapy and/or radiotherapy may be taken into consideration 1.
- A locoregional adjuvant treatment should be considered due to the high incidence of local failure after surgical resection 1. However, the most recent and highest quality study is not available in the provided evidence, but based on the available evidence, surgical resection followed by adjuvant chemotherapy is the recommended treatment for T3N0M0 gallbladder cancer.
From the Research
Treatment for T3N0M0 Gallbladder Cancer
The treatment for T3N0M0 gallbladder cancer typically involves surgical resection. According to 2, a more aggressive surgical approach, including resection of the gallbladder, liver, and regional lymph nodes, is advisable for patients with T1b to T4 tumors.
Surgical Approach
- Radical cholecystectomy, which includes staging laparoscopy, hepatic resection, and locoregional lymph node clearance, is recommended to achieve R0 resection 3.
- Partial hepatectomy involving the gallbladder bed is a critical part of gallbladder cancer resection and is a safe procedure 4.
- Major hepatectomy and common bile duct excision should only be performed in select cases 5.
Adjuvant Therapy
- Adjuvant chemoradiation therapy is not recommended for patients with lymph node-negative T3N0M0 gallbladder cancer, as it does not show any gain in survival 6.
- However, adjuvant chemotherapy may be beneficial for patients with locally advanced disease (T3 or T4), hepatic-sided T2 tumors, node positivity, or R1 resection 3.
- The current standard of care for adjuvant therapy includes 6 months of oral capecitabine 5.