Advances in systemic therapy for gastrointestinal malignancies have opened the door for surgical resection of tumors previously deemed unresectable. Of these tumors, gallbladder cancer has a particularly poor prognosis due to the aggressive nature of the disease. The preferred systemic therapy regimen for gallbladder cancer has progressed from single-agent chemotherapy to multi-agent therapy including immune checkpoint inhibitors, with additional targeted therapies currently under investigation. These advancements have provided patients with historically unresectable tumors with a bridge to surgical resection and a hope of extended survival or cure. Surgical options for locally advanced tumors have expanded, and experienced centers perform a variety of operations to achieve resection with negative margins, including extended liver resection, bile duct resection, vascular reconstruction, and adjacent organ resection. There is also growing evidence that patients with Stage IV disease may benefit from resection of their primary tumors and metastases. This review outlines the current treatment practices for patients with locally invasive and metastatic gallbladder cancer as well as emerging treatment options.
胃肠道恶性肿瘤系统性治疗的进展，为既往被认为不可切除的肿瘤提供了手术切除的可能性。其中，胆囊癌因疾病侵袭性强，预后尤其不良。胆囊癌的首选系统性治疗方案已从单药化疗发展为包含免疫检查点抑制剂在内的多药联合治疗，目前还有更多靶向疗法正处于研究阶段。这些进展为既往无法手术的肿瘤患者搭建了通向手术切除的桥梁，带来了延长生存期乃至治愈的希望。局部晚期肿瘤的手术方案范围已得到扩展，经验丰富的医疗中心可实施多种手术以实现切缘阴性的肿瘤切除，包括扩大肝切除、胆管切除、血管重建及邻近器官切除。此外，越来越多的证据表明，IV期患者也可能从原发灶及转移灶的切除中获益。本综述概述了当前针对局部浸润性和转移性胆囊癌患者的治疗实践以及新兴的治疗方案。
Surgical Management of Locally Advanced and Metastatic Gallbladder Cancer
肿瘤(癌症)患者之家