Patients presenting with gallbladder mass on imaging or operative exploration:
■ T2/3, N0/1, M0: radical cholecystectomy and lymph node dissection
■ Unilateral vascular involvement: extended lobectomy and lymph node dissection
■ T4, N0/1, M0: extended lobectomy and lymph node dissection, possible adjacent organ resection
■ N2 or M1: no curative surgery, possible palliation by biliary or gastric bypass
Patients with cancer discovered as an incidental finding after cholecystectomy for presumed cholelithiasis:
■ T1 with negative liver and cystic duct margin: no further therapy
■ T1 with positive cystic duct margin: re-resection of cystic duct or common bile duct to negative margins
■ T2/3/4, M0: extended lobectomy, common bile duct resection, lymph node dissection, and resection of laparoscopic port sites
■ N2 or M1: no curative surgery (palliation)
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