All the following statements regarding cancer of the gallbladder are true EXCEPT
|A||Most affected patients are females|
|B||Most affected patients have associated gallstones|
|C||Treatment should include right hepatic lobectomy|
|D||The prognosis for 5-year survival is less than 5 percent|
a. Cancer of the gallbladder is an aggressive malignancy that occurs predominantly in elderly people
b. Cancer of the gallbladder is two to three times more common in women than men, in part because of the higher incidence of gallstones in women.
c. More than 75% of patients with this malignancy are older than 65 years.
Risk Factors for Gallbladder Carcinoma
d. Patients with tumors confined to the gallbladder mucosa or submucosa (T1a) or confined to the gallbladder muscularis (T1b) are usually identified after cholecystectomy for gallstone disease and have an overall 5-year survival rate approaching 100% and 85%, respectively.
e. Cancer of the gallbladder with invasion beyond (stages II and III) the gallbladder muscularis is associated with an increased incidence of regional lymph node metastases and should be managed with an “extended cholecystectomy.”
f. This includes lymphadenectomy of the cystic duct, pericholedochal, portal, right celiac, and posterior pancreatoduodenal lymph nodes.
g. Obtaining an R0 resection should be the goal of surgery and results in an improved survival compared with patients who have remaining microscopic or macroscopic disease.
h. Extension into the hepatic parenchyma is common, and extended cholecystectomy should incorporate at least a 2-cm margin beyond the palpable or sonographic extent of the tumor.
i. For smaller tumors, this goal can be achieved with a wedge resection of the liver. For larger tumors, an anatomic liver resection (extended right hepatectomy) may be required to achieve a histologically negative margin.
j. Staging laparoscopy should be performed in patients with gallbladder cancer, as a high proportion (50%-55%) of patients have hepatic or extrahepatic disease that is not detected by noninvasive staging modalities.