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FOREWORD
Thefrequencyofgallbladdercancerisincreasing,and
prognosisisoftenpoor.Manypatientsareasymptoma-
ticuntilthetumorprogresses.InEurope,themajorityof
patientsisdiagnosedatlatestage,hencebetterstrategies
forsurveillanceandtimelytreatmentareneeded.How-
ever,gallbladdercancerhasnotattractedmajorconcerted
researcheffortstodate.Therefore,weverymuchappreci-
atetheeffortsoftheeditorsandauthorsofthecurrent
booktoprovideacomprehensiveoverviewongallbladder
cancer.
Surgicalresectionrepresentsthecurativeoptionfor
gallbladdercancer,andthecancermaybediagnosed
unexpectedlyduringcholecystectomyforsymptomatic
gallstones.Earlydetectionisaprerequisiteforcurative
therapy.Hence,ultrasound-basedscreeninghasbeen
suggested,butfeasibilityatthepopulationscaleand
cost-effectivenesshaveyettobedemonstrated.Since
gallstonediseaserepresentsabonafideriskfactorfor
gallbladdercancer,personalizedpreventionstrategies
canbeenvisioned.
Ofnote,theincidenceofgallbladdercancerhasde-
clinedinmanyEuropeancountries,probablyduetothein-
creasingnumberofcholecystectomies.Infact,between1980
and1999theage-standardizedratesdecreasedby30%to
1.8/100000inwomen,andby10%to1.4/100000inmen.
However,thisisnotthecaseinallcountries.Forexample,in
Polandnosignificantreductioninthefrequencyofthistu-
morhasbeenreportedtodate,althoughthecountryreports
ahighincidenceofgallbladdercancer.
Whatcouldbedoneinthefuturetoimprovetheprog-
nosisinpatientswithgallbladdercancer?Giventheag-
gressivenatureofthistumor,thedevelopmentofnovel
multimodaltreatmentstrategiesseemstobeofprime
importanceinimprovingsurvival.Inaddition,weneedto
betterunderstandofgallbladdercancerpathogenesisand
todefinethemechanismsthatpromotethedevelopment
ofthistumorinpatientswithknownriskfactorssuchas
hereditarygallbladderstonesorprimarysclerosingchol-
angitis.Thisstepwillrequireaclosecooperationbetween
scientistsandphysicianswiththeaimtodesigninnovative
translationalstudies.
Currently,amultidisciplinaryapproachiscriticalto
improvethequalityoflifeofpatientswithgallbladder
cancer,alsoduringthepalliativestageofthedisease.This
isreflectedbythelayoutofthebook,whichcoverstopics
rangingfromdiagnostictoolsandimagingtothelatest
therapeuticoptions,whichcanbeofferedinthesetting
ofgallbladdercancer.Oncethedefinitivetherapeuticop-
tionsarenolongeravailable,palliativeradiologicorendo-
scopicproceduresshouldbediscussed,aspresentedinthe
respectivechapters.Finally,asoutlinedinoneofthefinal
chaptersofthebook,anetworkofspecialistsisrequiredto
providethebestevidence-basedapproachtoindividualpa-
tientswithgallbladdertumors.Giventhebroadexpertise
oftheauthorswhocontributedtothisbookwearesure
thatitwillserveasauthoritativecompendiumthatpro-
videsanup-to-dateoverviewontreatmentandhealthcare
forpatientswithgallbladdercancer.
Univ.-Prof.Dr.
med.Matthias
Glanemann
Univ.-Prof.
Dr.med.
FrankLammert
Head,Department
ofGeneral,
Visceral,
Vascularand
PediatricSurgery
SaarlandUniversity
MedicalCenter
SaarlandUniversity,
Homburg,
Germany
Presidentof
theGerman
Gastroenterology
Association
(DGVS)
Head,Department
ofMedicineII
SaarlandUniversity
MedicalCenter
SaarlandUniversity,
Homburg,
Germany
Przedmowa
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