Clinical Medicine Reviews in Oncology

A large number of patients with advanced gall bladder cancer present with surgical obstructive jaundice caused by infiltration of the common bile duct by a gall bladder neck tumor. The investigation of choice is magnetic resonance imaging with cholangiography and angiography, which delineates the extent of biliary ductal involvement and the involvement of hepatic artery and portal vein in the hepatoduodenal ligament. Positron emission tomography and staging laparoscopy are useful to detect distant metastases which contraindicate resection. Major hepatectomy in the form of extended right hepatectomy is required to achieve R0 resection; preoperative preparation includes biliary drainage and portal vein embolization. Duodenal involvement may necessitate hepatopancreatoduodenectomy, but it is not recommended for gall bladder cancer. Mortality, however, remains high and long-term survival is anecdotal. Very few patients are candidates for resection; most require palliation from biliary and gastroduodenal obstruction by nonsurgical (endoscopic and/or radiological) intervention. Jaundice in gall bladder cancer is akin to the yellow traffic signal – stop, look and, then only, proceed!