Extent of Resection According to Stage

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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