Radical (extended) cholecystectomy

This is the UK baseline for the incidental cancer pathway: a re-resection rate well above the Dutch registry's 24 percent, with the same selection caveat. The UK layer of this deep dive should read the full paper for the histology, referral and timing detail the abstract leaves out.

The adjuvant finding sits uneasily beside BILCAP, on which NHS adjuvant capecitabine rests; in a mostly gallbladder population the benefit is not visible. ACTICCA-1 and ARTEMIDE-Biliary01 are the trials that can settle it.

It softens the Ethun four-to-eight-week rule: timing within the range that services can deliver probably matters less than completing the operation at all and doing it with the liver bed and nodes cleared.

Japanese surgeons operate on gallbladder cancer far more often than UK surgeons and their guideline addresses prevention (pancreaticobiliary maljunction, polyps) as a clinical topic, which Western guidelines do not.

The prognostic split is solid; the surgical consequence is not. Whether T2a tumours can safely skip liver resection, and whether T2b tumours gain from it, is a randomised or prospective-registry question that nobody has yet run.

Consistent with Kang and colleagues on prognosis, and more optimistic about liver resection for T2b. The adjuvant chemotherapy finding is retrospective and predates gallbladder-specific analysis of BILCAP, but it is a warning that the adjuvant benefit in this disease is not established.

A whole-country picture of the gap between guideline and practice: three quarters of eligible patients never reached the second operation. The survival difference is confounded by selection but the residual disease rate is not.

The UK-authored summary that most NHS hepatobiliary units work from; it names the open questions (type, extent and timing of re-resection; adjuvant chemotherapy) that the trials in this roadmap are trying to answer.

The strongest data against routine re-resection for T1b tumours, which guidelines still recommend. A prospective study or registry with standardised pathology is the missing step; the authors' own conclusion is that extended cholecystectomy is not needed for T1b.

The origin of the widely quoted four-to-eight-week window for re-resection. A 2026 individual patient data meta-analysis found no survival difference by timing, so the window is a reasonable planning target rather than a proven rule.

One of the series that raised the question of sparing the liver resection in T2a disease; only 33 peritoneal-side tumours, so it poses the question rather than settles it.

This is the observational backbone of the rule that T1b or deeper incidental cancers should be re-resected, and of resecting the bile duct only when the cystic duct margin is positive.