{"entity":{"id":"paper-varshney-neoadjuvant-incidental-gallbladder-cancer-systematic-review-ahbps-2025","kind":"paper","name":"Neoadjuvant treatment for incidental gallbladder cancer: A systematic review","aka":[],"tldr":"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.","asOf":"2026-09-24","links":[{"label":"Ann Hepatobiliary Pancreat Surg 2025","url":"https://doi.org/10.14701/ahbps.24-223"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/40064481/"}],"tags":["gallbladder-evidence"],"related":[],"cancers":["gallbladder"],"sections":[],"technologies":[],"targets":[],"drugs":["gemcitabine-cisplatin"],"companies":[],"institutions":[],"pathways":[],"terms":["incidental-gallbladder-cancer","neoadjuvant-adjuvant"],"trials":["opt-in","gain-igbc"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"journal":"Annals of Hepato-Biliary-Pancreatic Surgery","year":2025,"doi":"10.14701/ahbps.24-223","pmid":"40064481","authors":"Varshney P, Baghmar S, Sirohi B, et al.","paperType":"review","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."],"whatItMeans":"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."],"changedPractice":false},"route":"/key-papers/paper-varshney-neoadjuvant-incidental-gallbladder-cancer-systematic-review-ahbps-2025/","neighbours":{"cancer":[{"id":"gallbladder","kind":"cancer","name":"Gallbladder cancer","route":"/cancers/gallbladder/"},{"id":"incidental-gallbladder-cancer","kind":"cancer","name":"Incidental gallbladder cancer (found after cholecystectomy)","route":"/cancers/incidental-gallbladder-cancer/"}],"drug":[{"id":"gemcitabine-cisplatin","kind":"drug","name":"Gemcitabine + cisplatin","route":"/drugs/gemcitabine-cisplatin/"}],"term":[{"id":"neoadjuvant-adjuvant","kind":"term","name":"Neoadjuvant / adjuvant / perioperative","route":"/terms/neoadjuvant-adjuvant/"}],"trial":[{"id":"gain-igbc","kind":"trial","name":"GAIN (AIO/CALGP/ACO)","route":"/trials/gain-igbc/"},{"id":"opt-in","kind":"trial","name":"OPT-IN (EA2197)","route":"/trials/opt-in/"}],"idea":[{"id":"idea-gbc-neoadjuvant-for-high-risk-incidental-cancer","kind":"idea","name":"Chemotherapy before the second operation for high-risk incidental gallbladder cancer","route":"/ideas/idea-gbc-neoadjuvant-for-high-risk-incidental-cancer/"}]}}