Subsequent studies, including studies from India where the incidence is much higher, showed better survival. One, for example, demonstrated 50% survival among resected patients with jaundice; another demonstrated 23% 5-year survival.
"So the current recommendation is that the presence of jaundice is still a contraindication [to resection], but not an absolute contraindication," Dr. Are said.
It is a relative contraindication in selected patients; those with appropriate T stage who are fit enough for surgery and anesthesia should proceed to surgery, he added, noting that in those who are unresectable, it is important to think of biliary drainage.
"Unless you do that, it will be hard for them to get chemotherapy," he said.
• Extent of hepatic resection. The standard of care with respect to hepatic resection at the time of radical cholecystectomy is to resect only segments 4b and 5 of the liver. The controversy is whether more should be resected.
Data as to whether more extensive resection confers a survival benefit have been conflicting, with some studies showing a benefit with right lobectomy or extended right lobectomy, and others showing no such benefit, Dr. Are said.
The current standard of resecting 4b and 5 is adequate, except in selected cases where the intent of resecting more is to obtain negative margins, he said.
Dr. Are reported having no relevant disclosures.