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Which surgery for gallbladder cancer?

The surgery you need to have depends on the stage of your cancer. There are a number of possible operations used to try to remove gallbladder cancer.

Simple cholecystectomy

You have your whole gallbladder removed in this operation, and nothing else. You may have a cholecystectomy using a laparoscope. This is called a laparoscopic cholecystectomy (‘keyhole surgery’).

Extended or open cholecystectomy

If the cancer has spread throughout your gallbladder, your surgeon will then remove your whole gallbladder, about 2.5 cm (1 inch) of liver tissue nearest to the gallbladder, and all the surrounding lymph nodes. This is done to try to remove any cancer in these surrounding tissues.

Radical gallbladder resection

If the cancer has spread outside your gallbladder to nearby lymph nodes, you will need a bigger operation. Your surgeon will remove some of the surrounding tissues and lymph nodes. You may need to have other organs removed such as the pancreas, duodenum or part of your bowel.

Surgery to relieve symptoms (palliative surgery)

Even if your gallbladder cancer cannot be cured, you may need surgery to relieve your symptoms.

 

CR PDF Icon You can view and print the quick guides for all the pages in the treating gallbladder cancer section.

 

How your surgeon decides which type of operation

The amount of surgery you need will depend on the stage of your gallbladder cancer. The tests you have had help your specialist to decide if surgery is possible for you. But your doctor may not be able to tell you exactly what stage your cancer is until after your operation. Your surgeon may suggest surgery to

 

Surgery to remove the cancer (and gallbladder)

A number of possible operations are used to try to remove cancer of the gallbladder. Some of them are extremely major surgery. They are all done under general anaesthetic. So you will be asleep for the whole operation. The type of operation you have depends on where the cancer is in the gallbladder and how far it has spread outside your gallbladder. You may have

Here is more information about what happens when you have one of these operations.

Removal of the gallbladder (simple cholecystectomy)

This is often called a simple cholecystectomy. You have your whole gallbladder removed in this operation, and nothing else. The name cholecystectomy comes from the Greek word for gallbladder (cholecyst). Chole means bile and cyst means small sack. The end of the word, ectomy, is also Greek, meaning surgery to remove a part of the body. So a cholecystectomy is an operation to remove the bile sack.

You always used to have the upper right side of your tummy (abdomen) opened up to have a simple cholecystectomy. But some people can now have this operation with a laparoscope - a long fibre optic tube with a light and an eyepiece that the surgeon uses to look inside the body. You may hear this called keyhole surgery but the proper name for it is laparoscopic cholecystectomy.

You have the operation under general anaesthetic, so you will be asleep throughout. Your surgeon will make 3 or 4 small cuts (called port sites) in your abdomen. They then put a needle into your abdomen and pump carbon dioxide gas inside. The gas is harmless. It helps to make some space inside your abdomen for the doctor to move the laparoscope around freely and put in any instruments that are needed. While watching the operation down the eyepiece or on a screen, the surgeon will then cut away and remove your gallbladder.

Removal of the gallbladder, lymph nodes and part of the liver (extended or open cholecystectomy)

If the cancer has spread throughout your gallbladder then the surgeon will have to change the operation from a simple cholecystectomy to an extended cholecystectomy. Your surgeon will then take out

  • All your gallbladder
  • About 2.5 cm (1 inch) of liver tissue which is nearest to the gallbladder
  • All the lymph nodes around your gallbladder
  • Tissue surrounding the site of any previous keyhole surgery to the gallbladder

This is done to try to make sure that any cancer cells in the surrounding tissues are removed. In the lab a pathologist will examine all the tissues that the surgeon takes out. They will look for clear margins. This means that the surgeon has been able to remove all the cancer plus a surrounding border of tissue that is cancer free. Having clear margins helps to lower the risk of the cancer coming back.

Removal of the gallbladder and surrounding tissues (radical resection)

If the cancer has spread outside your gallbladder to nearby lymph nodes, your surgeon will do an even bigger operation. The surgeon will remove

  • Your gallbladder
  • A small part of the liver close to the gallbladder
  • Your common bile duct
  • Part or all of a fibrous strap (a ligament) that connects your liver and intestines
  • The lymph nodes from around nearby organs such as the liver, stomach, intestines and pancreas
  • Tissue surrounding the site of any previous keyhole surgery to the gallbladder
 

Surgery to remove nearby organs affected by the cancer

If your surgeon thinks the cancer has spread to other organs in your body, you may need to have them removed. This can include taking out

  • Your pancreas
  • Your duodenum (the beginning of your small bowel)
  • A larger part of your liver
  • Any other parts of organs that contain cancer cells, for example your stomach or part of your bowel

If you have any other organs taken out during your gallbladder operation, your doctor may call the operation

Gastrojejunostomy

In a gastrojejunostomy, your surgeon takes out your gallbladder, bile ducts and duodenum and reconnects your stomach to your small bowel (intestine).

Liver (hepatic) resection

Hepatic resection means taking out part of your liver. Your surgeon may do this if the cancer has spread from your gallbladder to part of your liver. It is only usually possible to do this if the cancer is small and when there are no major blood vessels affected by the cancer.

A lobectomy

Lobectomy means removing a lobe of the liver. The full name for this is hepatic lobectomy. If you have no medical problems with your liver (such as cirrhosis) it is possible for the liver to grow back and work normally after surgery.

It is important that your liver function is carefully checked before you have surgery. As the liver is such a vital organ, your doctors need to know that the remaining part of your liver can work well enough after your operation. If you have cirrhosis, your liver may not work well enough for your body to cope. Liver failure after surgery is much more likely in people who have cirrhosis.

Hepatopancreatoduodenectomy

Hepatopancreatoduodenectomy means taking out your pancreas, duodenum and some liver tissue.

Pancreatoduodenectomy

Pancreatoduodenectomy is also known as a Whipple’s operation. It used to be called a Kausch-Whipple's, but this term isn't often used any more. A Whipple's operation means removing

  • Part of your pancreas
  • Your duodenum (the first part of your small bowel)
  • Part of your stomach
  • Your gallbladder and part of your bile duct

Large bowel resection

Large bowel resection means taking out part of the large bowel (colon). This will be done if there are signs that the cancer has spread to your large bowel. The affected part of the bowel is cut out and the two ends rejoined.

 

Surgery to relieve symptoms (palliative surgery)

Even if your gallbladder cancer cannot be cured, you may need to have surgery to relieve your symptoms. This can give you a better quality of life for longer. You are most likely to need this type of treatment if your cancer is blocking your bile duct or bowel and making you feel or be sick. Unblocking your bile duct can also relieve jaundice symptoms such as severe itching and generally feeling ill. There are 2 types of procedure that can be done

  • A biliary bypass
  • Insertion of a catheter or stent

A biliary bypass means that the surgeon will cut your gallbladder or bile duct above the blockage and reconnect it to your small bowel (intestine). This allows the bile to go around (bypass) the cancer.

Small tubes called stents, or larger tubes called catheters, can help to drain bile that is blocked by the tumour. You may need to have a catheter that drains bile into a bag outside your body. Or you may be able to have a stent put inside the bile duct to drain bile around the blocked area and into the small bowel. Most stents now are made of an expandable wire mesh which makes them less likely to block. If a stent does get blocked it is often possible to unblock it, or put in a new stent. If this is not possible your jaundice will come back.

There is more about treatment in the advanced gallbladder cancer section, including more about stents.

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Updated: 22 August 2012