Gallbladder carcinoma surgical therapy. An overview.

Carcinoma of the gallbladder is the most frequent tumor of the extrahepatic biliary tract, and the fourth commonest upper gastrointestinal malignancy. Of the histologic types, adenocarcinoma is the most frequent (80%) (1,2). Gallbladder cancer probably has a multifactorial etiology. More than 80% of patients diagnosed with gallbladder cancer have gallstones. Karyotipic abnormalities, such as mutation of the tumor suppressor gene p53, which is located on the short arm of chromosome 17, are common in gallbladder cancer. Anomalous junction of the cystic duct and the common bile duct, pancreatobiliary maljunction, cystic disorders of the biliary tree or gallbladder polypoid lesions have been observed frequently in patients with gallbladder cancer (3,4). (gallbladder veins drain directly into the liver bed and are tributaries of the middle hepatic vein), c) lymphatic invasion (9). Loco-regional lymph nodes are disposed along the main arteries and include the cystic duct, pericholedochal, hilar (hepatoduodenal ligament, inferior caval vein), peripancreatic (head), periduodenal, periportal, coeliac, superior mesenteric and para-aortic lymphatic chains (10,11). The TNM classification and stage grouping criteria are useful to predict survival and decide therapy (Tables I-IV) (12).