Surgery is the only curative treatment for gallbladder cancer.

Known, Resectable Disease

Surgery is always recommended for stage I-III disease in an attempt to achieve cure.

  • Stage T1a disease can be treated with simple cholecystectomy only
  • All other stages require radical cholecystectomy
    • T2 disease requires at least some resection of liver as tumour may be present within the normal excision margin of the gallbladder
    • Some surgeons advocate partial hepatectomy as part of standard radical cholecystectomy, as this increases 5 year survival from 25% to 40%
    • T3 and T4 tumours with involvement of adjacent organs have previously been managed conservatively but aggressive surgical resection may improve survival (including pancreato-duodenectomy, colectomy or nephrectomy).
  • The extent of nodal dissection is also controversial
    • Removal of the porta hepatitis nodes is usually indicated
    • Para-aortic nodal dissection may provide prognostic information but has no impact on survival

Adjuvant Therapies


Chemotherapy has been evaluated in randomised controlled trials but results are mixed. In the adjuvant setting, mitomycin-C and 5-FU were evaluated by Takada et al in 2002; the 5 year survival was doubled (13 to 26%) in the treatment arm. Studies in the metastatic setting (see below) have established gemcitabine and cisplatin as the doublet of choice.


Retrospective data showing control rates that are superior with chemoradiotherapy compared with historical controls suggest chemoradiotherapy may be appropriate. Radiotherapy is given concurrently with 5-fluorouracil (5 year survival 33%).

Radiotherapy alone

There is minimal evidence for this approach.

Unresectable Disease

Unresectable disease is associated with a dismal survival of < 1% at 5 years.


Current treatment utilises gemcitabine with cisplatin. This improves median survival in metastatic disease from about 8 (with no treatment) to 12 months.


There is no evidence for the role of radiotherapy in the setting of unresectable gallbladder disease.