See in clinic for resection Histology discussion in SMDT Incidental finding on pathologic review Histology: T-stage, resection margin status, signs of perforation, cystic duct margin Surgical information: completeness of surgery/perforated or not/location of the tumour SMDT- Histology review T1a T1b or greater CT chest, abdomen, and pelvis +/- MRI liver Observe SMDT Resectable Resectable not fit for surgery ★Unresectable T1b T2/T3 (Exclude T3 with perforation) Referral to oncology for chemotherapy/chemoRT/best supportive care Type of chemotherapy- Gem/cisplatin or Fluoropyrimidine therapy /clinical trial See in clinic for resection Hepatic resection (IVb and V resection and ✜lymphadenectomy) should be considered (evidence is not clear) En-bloc hepatic resection (IVb and V resection) + ✜lymphadenectomy+/- bile duct resection (only for positive cystic duct margin) ★Presence of Metastasis/Contralateral hepatic artery/portal vein involvement /Aorto-caval /para-aortic nodal involvement ★Cystic lymph node, nodes in the hepatoduodenlal ligament, superior pancreatico-duodenal node (N1 GROUP) Follow up in 4-6 weeks Histology discussion in SMDT Lymph node involvement according to the T stage- pT1a, 0%-2.5%; pT1b, 5%-16%; pT2, 9%-30%; T3, 39%-72%; and T4, 67%-80% PHNT patients FUP by HPB/Oncology Non-PHNT patients FUP by local oncology team

GB mass on imaging with or without jaundice Suspicious GB mass at laparoscopy/laparotomy Non-PHNT PHNT Frozen section Open & close and referral to HPB team +ve for cancer No malignancy CT chest, abdomen, and pelvis/MRI liver/LFTS/CEA/CA19.9 Resectable ★Unresectable SMDT ★Unresectable (Para-aortic nodal involvement is a relative contraindication for surgery Cholecystectomy Resectable not fit for surgery Resectable See in clinic for resection and CPET Referral to oncology for chemotherapy/best supportive care Type of chemotherapy- Gem/cisplatin or Fluoropyrimidine therapy /clinical trial En-bloc hepatic resection (IVb and V resection+portal-hepatis lymphadenectomy +/- bile duct resection (Aim should be R0 Resection) ★Presence of Metastasis Contralateral hepatic artery/portal vein involvement /Aorto-caval /para-aortic nodal involvement Follow up in 4-6 weeks Histology discussion in SMDT T- stage Tis: Cancer cells are only found in the epithelium (the inner layer of the gallbladder) and have not grown into deeper layers of the gallbladder. This is also known as carcinoma in situ. T1: The tumor has grown into the lamina propria or the muscle layer (muscularis). T1a: Tumor has grown into lamina propria. T1b: Tumor has grown into the muscularis. T2: The tumor has grown into perimuscular fibrous tissue. T3: The tumor has grown through the serosa (the outermost covering of the gallbladder) and/or it has grown from the gallbladder directly into the liver and/or a nearby structure such as the stomach, duodenum (first part of the small intestine), colon, pancreas, or bile ducts outside the liver. T4: The tumor has grown into one of the main blood vessels leading into the liver (portal vein or hepatic artery) or it has grown into 2 or more structures outside of the liver. Non-PHNT patients FUP by local oncology team PHNT patients FUP by HPB/Oncology