Premalignant Lesions of the Gallbladder

This chapter reviews premalignant lesions of the gallbladder. Gallbladder adenocarcinomas (GBC) are highly aggressive malignancies with an overall poor prognosis. The survival for gallbladder cancer is strongly correlated to the stage, with early-stage GBC having the most favorable prognosis. Therefore, detection in premalignant or precursor stages is of paramount importance. The pertinent classification systems for premalignant gallbladder lesions are summarized, and the management of both grossly visible (polypoid) and flat premalignant lesions of the gallbladder is discussed. Surgical resection in the form of cholecystectomy is recommended for gallbladder polyps greater than 1 cm in size. In patients with primary sclerosing cholangitis, cholecystectomy should be offered to those with polyps 6–9 mm and reasonable surgical risk. There are multiple published guidelines recommending variable surveillance for polyps not meeting the criteria for resection. The general consensus is that in the absence of growth, surveillance can be discontinued after 2–5 years of follow-up.