Surgical procedure determination based on tumor-node-metastasis staging of gallbladder cancer

Table 1 AJCC staging classification system of gallbladder carcinoma, 7^th edition

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor invades lamina propria or muscle layer
T1a Tumor invades lamina propria
T1b Tumor invades muscle layer
T2 Tumor invades muscle layer, no extension beyond the serosa or into the liver
T3 Tumor perforates the serosa and/or directly invades the liver and/ or one other adjacent organ or structure
T4 Tumor invades main portal vein or hepatic artery or invade two or more extrahepatic organs or structures
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastases
N1 Metastases to nodes along the cystic duct, common bile duct, hepatic artery, and/or portal vein
N2 Metastases to periarotic, pericaval, and/or celiac artery lymph nodes
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis
Stage 0	Tis	N0	M0
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage IIIA	T3	N0	M0
Stage IIIB	T1-3	N1	M0
Stage IVA	T4	N0-1	M0
Stage IVB	Any T	N2	M0
	Any T	Any N	M1

Table 2 Patient demographics and tumor differentiation characteristics n (%)

Item	Number	Simple cholecystectomy	Radical cholecystectomy	Palliative resection	No surgery
Age
mean ± SD	63.75 ± 11.86	66.61 ± 11.07	62.75 ± 11.38	63.53 ± 13.19	63.68 ± 12.01
Range	29-89	50-89	36-85	29-81	39-83
Sex
Male	61 (40.13)	10 (16.39)	22 (36.07)	13 (21.31)	16 (26.23)
Female	91 (59.87)	18 (19.78)	33 (36.26)	18 (19.78)	22 (24.18)
Differentiation
High	26 (17.11)	10 (38.46)	6 (23.08)	8 (30.77)	2 (7.69)
Median	50 (32.89)	9 (18.00)	26 (52.00)	7 (14.00)	8 (16.00)
Low	42 (27.63)	3 (7.14)	20 (47.62)	11 (26.19)	8 (19.05)
No report	34 (22.37)	6 (17.65)	4 (11.76)	4 (11.76)	20 (58.82)
Total	152	28 (18.42)	57 (37.50)	28 (18.42)	39 (25.66)

Table 3 Patient numbers of various treatments in each tumor-node-metastasis staging group n (%)

TNM stage	Case	Simple cholecystectomy	Radical cholecystectomy	Palliative resection	Inoperable	P value1
0 + I	18 (11.84)	12 (66.67)	6 (33.33)	0	0	0.826
II	25 (16.45)	16 (64.00)	9 (26.00)	0	0	0.114
IIIA	21 (13.82)	0	12 (57.14)	9 (42.86)	0	0.034
IIIB	21 (13.82)	0	11 (52.38)	10 (47.62)	0	0.701
IVA	24 (15.79)	0	19 (79.17)	2 (8.33)	3 (12.50)	0.6862
IVB	43 (28.29)	0	0	7 (16.28)	36 (83.72)	0.001
Total	152	28 (18.54)	57 (37.50)	28 (18.42)	39 (25.66)

¹The P value refers to comparisons of survival times between patients with different surgical procedures in the same TNM stage;

²Palliative resection and non-surgical treatment were combined to compare with radical cholecystectomy. TNM: Tumor-node-metastasis.

Table 4 Postoperative complications presented in different stage groups

TNM stage	Surgical procedures	Age(mean ± SD)	P value		Complication
0-I	Simple cholecystectomy	61.58 ± 10.587	0.662	1	Infection under the skin incision with gallbladder bed bleeding
	Radical cholecystectomy	64.17 ± 13.527		0
II	Simple cholecystectomy	71.56 ± 9.893	0.371	0
	Radical cholecystectomy	68.22 ± 6.220		1	Fat liquefaction of incision
IIIA	Radical cholecystectomy	61.67 ± 12.397	0.367	0
	Palliative resection	67.00 ± 13.991		1	Biliary fistula
IIIB	Radical cholecystectomy	65.82 ± 7.973	0.510	0
	Palliative resection	62.20 ± 14.676		2	Biliary fistula, pulmonary embolism
IVA	Radical cholecystectomy	67.47 ± 9.553	0.066	3	MODS resulting from biliary tract infection (dead), deep vein thrombosis, deterioration of liver function
	Palliative resection and No surgery	57.80 ± 11.520		1	Lung infection
IVB	Palliative resection	65.57 ± 14.293	0.817	3	Abdominal infection, acute pulmonary edema, subphrenic effusion
	No surgery	64.39 ± 11.905		2	MODS (dead)

TNM: Tumor-node-metastasis.