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 abstract leaves out the histology, referral and timing detail; the full paper holds it.

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.