Gallbladder Cancer and Peritoneal Metastasis: Is there any role of Cytoreductive Surgery (CRS) and/or Hyperthermic Intraperitoneal Chemotherapy (HIPEC)? A Narrative Review.

INTRODUCTION: Gallbladder cancer (GBC) is the most common biliary tract cancer (BTC) worldwide-the majority of GBC patients present with locally advanced or metastatic disease. Peritoneum is one of the most common sites of metastasis in GBC and the most frequent site for recurrence after resection of both non-incidental and incidental GBC (iGBC). Ovarian, colorectal, and gastric cancers also commonly metastasise to the peritoneum, and the role of cytoreductive surgery (CRS) in the form of peritonectomy and hyperthermic intraperitoneal chemotherapy (HIPEC) procedures is well-documented for the treatment of peritoneal metastasis (PM) or peritoneal dissemination or carcinomatosis in these malignancies.

METHODS AND RESULTS: We found ten reports (including five single case reports) of CRS + HIPEC in GBC + PM-both iGBC and non-iGBC. The number of patients ranged from as small as 3-5 to as many as 80. Major morbidity was uncommon; median survival ranged from 7 to 22 months, with 3-year survival around 20-30%. Three reports, including 1, 22, and 35 patients, showed the benefit of prophylactic HIPEC in selected patients with advanced GBC at high risk of developing PM during follow-up.

CONCLUSION: CRS and/or HIPEC may have a role in the management of PM in GBC.