Gall Bladder Cancer - Is the Stage Set? Yet!

Abstract

The current TNM staging of gall bladder cancer (GBC) has some shortcomings. We propose some changes in the current TNM staging of GBC. We propose that involvement of muscularis propria should be classified as T2 (instead of current T1b) and stage grouped as II (instead of current I). T4 in GBC should be subdivided into T4a (perforation of serosa, involvement of omentum, CBD, stomach/duodenum and colon) and T4b (involvement of pancreas, hepatic artery and portal vein). Hepato-duodenal ligament lymph nodes alone should be classified as N1; periduodenal, peripancreatic and common hepatic artery lymph nodes should be classified as N2 and stage grouped as IVA; non-regional (distant) lymph nodes should be classified as M1a and distant (non-nodal) metastases should be classified as M1b. We also propose changes in the TNM stage grouping of GBC – stage I (T1 N0 M0), II (T2 N0 M0), III (T3 N0 M0, T1-3 N1 M0) and IV (T4 Any N M0, Any T N2 M0, Any T Any N M1). Tumors at GB neck are difficult to resect and have poorer prognosis even after resection. Surgical obstructive jaundice (SOJ) in GBC makes resection difficult and is associated with poorer prognosis even after resection. We also propose inclusion of non TNM factors viz. site of tumor (fundus/body or neck) and SOJ in staging of GBC.