Surgical Procedures:
Surgery for Gallbladder Cancer
Surgery offers the only chance of cure for gallbladder cancer. Unfortunately, most cases are too advanced at the time of presentation to cure. For potentially curable cancers, there are two types of operations possible, namely
- Laparoscopic (Keyhole Surgery) - reserved for very early cancers that have not left the inner lining of the gallbladder.
- Open surgery - for cancers that have locally spread into surrounding organs, but are still potentially curable.
For early cancers, the gallbladder is able to be removed in a similar manner as gallstone surgery. Click here to see a detailed description of keyhole surgery for gallbladder removal (laparoscopic cholecystectomy).
For more advanced, but still potentially curable gallbladder cancers, a more extensive resection is required which is best done with open surgery. This is because the tumour usually invades into the adjacent liver and part of the liver must be excised.
What does surgery involve?
Open surgery for gallbladder cancer is major surgery requiring full admission into hospital and a general anaesthetic.
The operation itself involves a transverse incision under the right lower rib cage to allow access to the gallbladder. Despite previous staging procedures, the abdominal cavity is thoroughly examined to exclude metastatic disease which staging tests sometimes miss. This occurs rarely with thorough preoperative staging techniques used by Dr Fenton-Lee.
Following this, the gallbladder and tumour are mobilised away from surrounding structures. Depending on the extent of tumour invasion, the gallbladder, and any involved surrounding organs are removed with a wide, safe surgical margin. This usually requires removing part of the liver, as this is most often involved. The tumour mass is then removed.
The abdominal cavity is then irrigated with warmed saline to reduce the chance of infection, a drain is inserted into the area the gallbladder was removed and the abdomen closed. Dressings are then applied to the wound.
What will i be like after the operation?
Upon arrival to the ward following surgery, a canula or fine tubing inserted into a vein remains to administer fluids and medications intravenously. The drain inserted at the end of the procedure also remains. Most patients will also have special stockings and twice daily injections of an anti clotting medication to help prevent deep vein thrombosis.
No oral intake is allowed for the first 1 or 2 days to allow the bowel to recovery from surgery. Pain control, early mobilisation and regular physiotherapy to reduce the chances of chest infections are routine post operative treatments.
Diet is slowly introduced over the following few days. The canula is no longer required once oral intake is adequate.
Patients are able to return home once they are mobilising independently, pain control is achieved with oral medications and they are tolerating a normal diet. This is generally achieved between 5 to 7 days following the operation depending on the extend of resection.
Prior to discharge, pathology results are discussed. If other forms of treatment such as radiotherapy are considered, this is arranged with specialist oncologists at St Vincent's Hospital during admission.
Due to the extent of the operation, rehabilitation and recovery continues at home. Full recovery often takes months to complete. Most people are back to full activities after 4-6 weeks. Post operative follow-up with Dr Fenton-Lee is arranged prior to discharge.
What complications can occur?
Complications from open surgery are rare, but include
- Bile Duct Injury
Bile may leak from a number of areas following cholecystectomy and the treatment of a bile leak depends on the source. In some instances, bile draining via the drain inserted during the operation is sufficient treatment, but in others further procedures or even re-operation is required.
- Bleeding/Infection
Significant bleeding during or following the operation is rare. Post operative infection within the abdomen or wound infection are also rare complications. These complications are reduced by the administration of a single dose of antibiotic at the time of operation.
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