# Neoadjuvant treatment for incidental gallbladder cancer: A systematic review

Source: https://onco.cc/key-papers/paper-varshney-neoadjuvant-incidental-gallbladder-cancer-systematic-review-ahbps-2025/  
OnCo record `paper-varshney-neoadjuvant-incidental-gallbladder-cancer-systematic-review-ahbps-2025` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

A review of whether chemotherapy should come before the second operation for gallbladder cancer found by chance: recurrences after that operation are early and distant, so treating the whole body first makes sense, and the limited evidence favours three to four cycles of gemcitabine-based chemotherapy in higher-risk cases.

## Summary

Systematic review by an international group including the GAIN and Indian investigators. Incidental gallbladder cancer is usually early stage, yet a high proportion recur within six months of radical re-resection, mostly at distant sites, which points to systemic disease. The review examines evidence for and against neoadjuvant systemic therapy before reoperation, proposes selection criteria and a regimen, and notes improved outcomes reported for reoperation 4 to 14 weeks after cholecystectomy compared with immediate reoperation. It concludes that limited but promising evidence supports 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy in selected high-risk cases.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: Annals of Hepato-Biliary-Pancreatic Surgery
- Year: 2025
- DOI: 10.14701/ahbps.24-223
- Authors: Varshney P, Baghmar S, Sirohi B, et al.
- Findings: Most recurrences after radical re-resection of incidental gallbladder cancer are distant and early (within six months).; Limited evidence supports 3 to 4 cycles of gemcitabine-based neoadjuvant chemotherapy in selected high-risk incidental cases; reoperation at 4 to 14 weeks is associated with better outcomes than immediate reoperation.
- What it means: The rationale for OPT-IN and GAIN in one place. Until OPT-IN reports in 2028 the neoadjuvant approach for incidental cancer remains a reasoned choice rather than a proven one.
- Caveats: Narrative synthesis of small retrospective series.; Authors include investigators of the trials under review.

## Sources

- Ann Hepatobiliary Pancreat Surg 2025: https://doi.org/10.14701/ahbps.24-223
- PubMed: https://pubmed.ncbi.nlm.nih.gov/40064481/

## Connected records

- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/)
- drugs: [Gemcitabine + cisplatin](https://onco.cc/drugs/gemcitabine-cisplatin/)
- terms: [Neoadjuvant / adjuvant / perioperative](https://onco.cc/terms/neoadjuvant-adjuvant/)
- trials: [GAIN (AIO/CALGP/ACO)](https://onco.cc/trials/gain-igbc/), [OPT-IN (EA2197)](https://onco.cc/trials/opt-in/)
- ideas: [Chemotherapy before the second operation for high-risk incidental gallbladder cancer](https://onco.cc/ideas/idea-gbc-neoadjuvant-for-high-risk-incidental-cancer/)

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