Gallbladder tumors are recognized with increasing frequency, as a consequence of improvements in imaging techniques and increased utilization of these studies. Approximately 5% of patients evaluated with ultrasonography (US) for abdominal pain will have a gallbladder polyp. Cancer of the gallbladder is uncommon, though it is the fifth most common gastrointestinal (GI) malignancy.
It is possible to cure gallbladder cancer when tumors are treated surgically at an early stage. Given that gallbladder polyps are common, it is important to identify those that carry a high risk of malignancy. The size of a gallbladder polyp is generally the strongest predictor of malignant transformation.
Benign lesions of the gallbladder are relatively common, but only adenomatous polyps are considered to have malignant potential. Although US can be useful in evaluating these lesions, considerable difficulty may be encountered in establishing the diagnosis preoperatively.
In 1924, Blalock suggested avoiding surgery on patients with gallbladder cancer if the diagnosis could be made preoperatively.
Therapeutic nihilism continued to define the approach to gallbladder cancer through most of the 20th century. Although most patients with gallbladder cancer continue to present with advanced disease, advances in imaging and hepatobiliary surgical techniques have made curative surgery possible in a greater number of cases.
The surgical approach to gallbladder cancer includes prevention, early detection, appropriate staging, and curative resection. Cholecystectomy is recommended for suspicious gallbladder polyps in order to facilitate early detection and treatment. Gallbladder cancer is commonly diagnosed incidentally following cholecystectomy or on the basis of preoperative imaging. The surgical indications are based on stage and margin status.