Curative surgical resection for initially unresectable metastatic gallbladder cancer following neoadjuvant chemotherapy: Case report and review of literature

BACKGROUND: Gallbladder cancer is a rare type of malignancy with overall poor prognosis. It represents the most common type of biliary tract cancer. Surgical resection can provide cure for those presenting in early stages. However, patients presenting with locally advanced or metastatic disease are considered unresectable and the first line of management in such cases is chemotherapy. CASE PRESENTATION: 60 years old Saudi female with no previous medical background who was diagnosed at local hospital to have unresectable metastatic gallbladder cancer to the liver. She received 6 cycles of neoadjuvant chemotherapy as the standard protocol (Gemcitabin + Cisplatin). She showed a good response and after a multidisciplinary tumor board decision was then taken for a successful curative surgical resection (R0). Post operatively, she had another 4 cycles adjuvant chemotherapy of the same regimen. She is still on active surveillance, alive in a good condition with no local recurrence or distant metastasis after 42 months post operatively. DISCUSSION: Patients with gallbladder cancer are often diagnosed at late stages and those with locally advanced or metastatic gallbladder cancer are not candidates for surgical resection, even though it is a principal part of management to achieve cure. A conversion surgical resection is yet possible in selected patients initially labeled as having unresectable gallbladder cancer following neoadjuvant chemotherapy. CONCLUSION: A conversion surgical resection can achieve cure in appropriately selected candidates initially labeled as unresectable gallbladder cancer following good response to neoadjuvant chemotherapy. Careful patient selection and multidisciplinary team management is recommended. Further studies are needed to standardized the management approach regarding criteria for eligible candidates, timing before considering conversion, and extent of resection.