关键词: 胆囊癌, 临床指南, Delphi共识, 流行病学, 胆囊息肉, 根治性手术, 局部进展期胆囊癌

Abstract: The “IHPBA-APHPBA clinical practice guidelines’: International Delphi consensus recommendations for gallbladder cancer” were developed by 45 global experts organized by the International Hepato-Pancreato-Biliary Association (IHPBA) and the Asia Pacific Hepato-Pancreato-Biliary Association (APHPBA) using the Delphi consensus method. The objective of these guidelines is to provide unified standards for clinical practice in gallbladder cancer. The guidelines focus on controversial issues on surgical treatment, the standardization of terminology, and resectability assessment, while comparing these recommendations to existing guidelines both domestically and internationally. Among the high-risk factors for gallbladder cancer, the consensus emphasizes the roles of dietary factors, environmental pollutants, and cholelithiasis, but clearly states that gallbladder adenomyomatosis is not a risk factor, which differs from domestic guidelines. For asymptomatic cholelithiasis patients, the consensus does not support prophylactic cholecystectomy to reduce the risk of gallbladder cancer, whereas domestic guidelines suggest elective surgery for high-risk patients. The treatment standards for gallbladder polyps are consistent with domestic guidelines: polyps with a diameter ≥1 cm should be removed; those ≥2 cm or with suspicious characteristics should undergo preoperative CT examination. Regarding pathological examination, the consensus recommends routine pathological examination for all gallbladder resection specimens to reduce the risk of misdiagnosis. In terms of surgical nomenclature and scope, radical cholecystectomy is defined as hepatectomy combined with lymphadenectomy of the hepatoduodenal ligament; extended radical cholecystectomy includes extensive hepatectomy and resection of extrahepatic organs or vessels. For incidental gallbladder cancer, patients with T1a stage can be observed, while those with T1b stage should undergo further surgery, but this decision should be based on the patient’s overall health condition. The extent of liver resection is determined by staging: wedge resection can be performed for T2 stage, while for T3 stage, there is a divergence between wedge resection and liver resection of the Ⅳb-Ⅴ segments. For lymphadenectomy, the consensus reached global agreement for the first time: patients with T1b stage and above should undergo standard D2 lymphadenectomy (No.8, No.12, No.13a lymph nodes), and if there is metastasis to the lymph nodes around the abdominal aorta (No.16b1), it is considered distant metastasis and surgery should be abandoned. Minimally invasive surgery is only recommended for early-stage cases, and routine use in advanced gallbladder cancer is not recommended. The consensus also introduces for the first time the evaluation criteria for borderline resectable/locally advanced gallbladder cancer (BR/LA-GBC), including hilar obstruction, lymph node metastasis, or vascular invasion. PET/CT is recommended for staging in locally advanced cases and for assessing response to neoadjuvant therapy. For metastatic cases, the consensus recommends palliative chemotherapy and palliative surgery should only be considered when necessary. These guidelines promote the standardization of gallbladder cancer management by regulating surgical treatment processes and definitions. However, due to regional healthcare differences, some recommendations should be applied flexibly in practice.

Key words: gallbladder cancer, clinical guidelines, Delphi consensus, epidemiology, gallbladder polyps, radical resection, locally advanced gallbladder cancer