Neoadjuvant treatment for incidental gallbladder cancer: A systematic review
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.
Overview
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.
- 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.
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.
- Narrative synthesis of small retrospective series.
- Authors include investigators of the trials under review.
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