# Radical (extended) cholecystectomy

Source: https://onco.cc/terms/radical-cholecystectomy/  
OnCo record `radical-cholecystectomy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The cancer operation for gallbladder cancer: the gallbladder (if still present) is removed together with a rim of the liver it sits against and the lymph nodes along the bile duct and liver blood vessels. After an incidental cancer it is done as a second operation about four to eight weeks after the first.

## Summary

Radical or extended cholecystectomy removes the gallbladder en bloc with the adjacent liver parenchyma (a wedge of the gallbladder bed or the anatomical segments IVb and V) and a portal (hepatoduodenal ligament) lymphadenectomy, with the aortocaval nodes assessed and a goal of at least six nodes recovered; the extrahepatic bile duct is resected only when needed for a clear margin, typically a positive cystic duct margin (AHPBA consensus, Aloia 2015). Glenn and Hays proposed the operation in 1954. It is recommended from T1b upwards and for T2 and T3 disease found incidentally, provided there is no advanced disease or poor fitness; patients with N2 (four or more nodes or aortocaval) involvement do not benefit (Aloia 2015; Soreide 2019). For incidental cancers the best interval is 4 to 8 weeks after the first operation (Ethun 2017). The T1b benefit is debated (Cho 2026; Rhodin 2024) and the choice between wedge and segmental liver resection for T2 is unsettled (Chen 2023). In the UK the operation is done in hepatobiliary centres, sometimes as a single stage guided by frozen section when cancer is suspected before surgery (Chan 2022; Banh 2024).

## Fields

- Kind: Term
- Last checked: 2026-09-24
- Also known as: Extended cholecystectomy; Re-resection for gallbladder cancer; Completion radical cholecystectomy; En bloc gallbladder and liver bed resection; Revision surgery; Liver bed resection with lymphadenectomy
- Tags: gallbladder; biliary

## Notes

- Evidence: the Dutch registry associates re-resection with far longer survival in an unmatched comparison (median 52.6 versus 13.7 months; de Savornin Lohman 2020), and in the UK CAPBIL study 97.9 percent of liver resections for incidental cancer were segment 4b/5 resections (McClements 2026). Whether T1b and peritoneal-side T2a tumours need the liver resection is contested (Kim 2018; Kang 2021).

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Cholecystectomy
- AHPBA expert consensus statement on gallbladder cancer (Aloia, HPB 2015): https://doi.org/10.1111/hpb.12444
- Soreide, Br J Surg 2019: systematic review of incidental gallbladder cancer after cholecystectomy: https://doi.org/10.1002/bjs.11035
- Ethun, JAMA Surg 2017: timing of re-resection for incidental gallbladder cancer: https://doi.org/10.1001/jamasurg.2016.3642
- Cho, Ann Hepatobiliary Pancreat Surg 2026: extended versus simple cholecystectomy for T1b, meta-analysis: https://doi.org/10.14701/ahbps.26-091
- Rhodin, HPB 2024: simple versus radical cholecystectomy for T1b in the National Cancer Database: https://doi.org/10.1016/j.hpb.2024.01.012
- Chan, J Surg Oncol 2022: intraoperative frozen section for suspected gallbladder cancer (Liverpool): https://doi.org/10.1002/jso.26726
- Banh, Int J Surg 2024: single-stage management of suspected gallbladder cancer with frozen section (London): https://doi.org/10.1097/js9.0000000000001456

## Connected records

- cancers: [Adenosquamous and squamous carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-adenosquamous-squamous-carcinoma/), [Carcinoma in situ and dysplasia of the gallbladder](https://onco.cc/cancers/gallbladder-carcinoma-in-situ-and-dysplasia/), [Cystic duct carcinoma](https://onco.cc/cancers/cystic-duct-carcinoma/), [Gallbladder adenocarcinoma](https://onco.cc/cancers/gallbladder-adenocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/), [Mucinous carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-mucinous-carcinoma/), [Neuroendocrine carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-neuroendocrine-carcinoma/), [Papillary carcinoma of the gallbladder](https://onco.cc/cancers/gallbladder-papillary-carcinoma/)
- terms: [Cystic duct margin](https://onco.cc/terms/cystic-duct-margin/), [Hepatectomy (liver resection)](https://onco.cc/terms/hepatectomy/), [Lymphadenectomy (lymph node dissection)](https://onco.cc/terms/lymphadenectomy/), [Port-site metastasis](https://onco.cc/terms/port-site-metastasis/), [Segment IVb and V liver resection (versus wedge resection)](https://onco.cc/terms/segment-ivb-v-resection/), [Simple cholecystectomy](https://onco.cc/terms/simple-cholecystectomy/), [T2a versus T2b gallbladder cancer (peritoneal side versus hepatic side)](https://onco.cc/terms/t2a-versus-t2b/)
- key papers: [Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival: A Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium](https://onco.cc/key-papers/paper-ethun-re-resection-timing-incidental-gallbladder-cancer-jama-surg-2017/), [Clinical practice guidelines for the management of biliary tract cancers 2019: The 3rd English edition](https://onco.cc/key-papers/paper-jshbps-biliary-tract-cancer-guidelines-2019-jhbps-2021/), [Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection](https://onco.cc/key-papers/paper-pawlik-incidental-gallbladder-cancer-residual-disease-jgs-2007/), [Management of incidental gallbladder cancer in the nationwide CAPBIL study](https://onco.cc/key-papers/paper-mcclements-capbil-incidental-gallbladder-cancer-bjs-2026/), [Optimal surgical treatment in patients with T1b gallbladder cancer: An international multicenter study](https://onco.cc/key-papers/paper-kim-t1b-gallbladder-cancer-international-jhbps-2018/), [Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis](https://onco.cc/key-papers/paper-kang-t2-gallbladder-cancer-location-meta-analysis-jcm-2021/), [Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease](https://onco.cc/key-papers/paper-de-savornin-lohman-re-resection-incidental-gallbladder-cancer-aso-2020/), [Surgical outcomes in gallbladder cancer: evidence from the UK nationwide CAPBIL study](https://onco.cc/key-papers/paper-mcclements-capbil-surgical-outcomes-gallbladder-cancer-hpb-2026/), [Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location](https://onco.cc/key-papers/paper-lee-t2-gallbladder-cancer-surgical-strategy-aso-2015/), [Systematic review of management of incidental gallbladder cancer after cholecystectomy](https://onco.cc/key-papers/paper-soreide-incidental-gallbladder-cancer-review-bjs-2019/), [Timing of revision surgery for incidental gallbladder cancer: a systematic review and individual patient data meta-analysis](https://onco.cc/key-papers/paper-selvakumar-revision-surgery-timing-ipd-meta-analysis-hpb-2026/), [Tumor location and concurrent liver resection, impact survival in T2 gallbladder cancer: a meta-analysis of the literature](https://onco.cc/key-papers/paper-khan-t2-gallbladder-cancer-liver-resection-meta-analysis-updates-surg-2021/)
- trials: [GAIN (AIO/CALGP/ACO)](https://onco.cc/trials/gain-igbc/), [NEOGB](https://onco.cc/trials/neogb/), [OPT-IN (EA2197)](https://onco.cc/trials/opt-in/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)
- ideas: [A national incidental gallbladder cancer pathway: histology for every gallbladder, referral within two weeks, re-resection by eight](https://onco.cc/ideas/idea-gbc-national-incidental-cancer-pathway/), [A trial of sparing the liver resection in peritoneal-side (T2a) gallbladder cancer](https://onco.cc/ideas/idea-gbc-t2a-spare-liver-resection-trial/), [Chemotherapy before the second operation for high-risk incidental gallbladder cancer](https://onco.cc/ideas/idea-gbc-neoadjuvant-for-high-risk-incidental-cancer/), [Test whether T1b gallbladder cancer needs the second operation at all](https://onco.cc/ideas/idea-gbc-t1b-simple-cholecystectomy-prospective-study/)
- technologies: [Surgery for gallbladder cancer: simple versus radical cholecystectomy, re-resection and lymphadenectomy](https://onco.cc/technologies/gallbladder-cancer-surgery/)

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