1. 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

2. 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