Surgical palliation of carcinoma of the gallbladder

Gallbladder cancer is the fifth most common gastrointestinal malignancy. Although overall 5-year survival is less than five percent, improved survival has been reported in recent years for extended resection of localized lesions. Nonetheless, one-third of operations for gallbladder cancer are palliative procedures. There is no universally suitable palliative surgical procedure and the choice of operation must take into account the general risk to the patient, the likely effect of surgery and the patient's principal symptoms of pain, jaundice and itch, nausea and/or vomiting. Cholecystectomy or drainage of the gallbladder may be necessary where obstruction of the cystic duct results in complication. Gastrointestinal bypass may be required for patients with gastric outlet obstruction. Although biliary bypass can be attempted to the extrahepatic biliary system or can be achieved by surgical intubation, there is increasing evidence that segment III cholangiojejunostomy provides effective long-term decompression of the obstructed biliary tree. A sound multidisciplinary approach is required in the management of these patients, the majority of whom are unlikely to survive beyond six months.