The possibility of liver lobe resection is considered in patients with carcinoma of gall bladder from/ beyond which stage of gall bladder carcinoma?
Ans. is 'b' i.e., IIA Following is the TNM classification of gall bladder carcinoma:Pathologic Staging of Gallbladder CarcinomaT(Primary Tumor) 111TXPrimary lumor cannol be assessedT0No evidence of primary tumorTisCarcinoma in situT1Tumor invades lamina propria or muscle layerT1aTumor invades lamina propriaT1bTumor invades muscle layerT2Tumor invades perimuscular connective tissue but not into liverT3Tumor perforates the serosa, or directly extends to the liver, or other adjacent organs, such as stomach, duodenum, colon, pancreas, omentum, or intrahepatic bile ductsT4Tumor invades main portal vein, or hepatic artery, or multiple extrahepatic organs or structuresN (Regional Lymph Nodes)NXRegional lymph nodes cannot be assessedN0No regional lymph node metastasisN1Regional lymph node metastasis.M (Distant Metastasis)MXDistant metastasis cannot be assessedMONo distant metastasisM1Distance metastasis Staging Gallbladder CancerStageTNM0TisNOMOIAT1NOMOIBT2NOMOIBT2NOMOIIAT3NOMOIIBTl+3N1MOIIIT4Any NMOIVAny TAny NMIManagement of Gall Bladder carcinoma:* The majority of patients have advanced disease at presentation, and are not candidates for surgical therapy.* Surgery is indicated in only very selected cases.* Cholecystectomy should be performed for all gall bladder polyps greater than 1 cm. Polyps less than 1 cm can be followed with serial ultrasonography to detect any change in size or character as the incidence of malignancy in polyps less than 1 cm is extremely low.* Radical en-bloc resections which may include segmental or extended hepatectomy, bile duct resection and regional lymphadenectomy should be considered in selected patients. The aim is to remove the tumour entirely and achieve negative histopathological margins. This option can be considered in the operable patients with carcinoma of gall bladder, who come under stage IIA of gall bladder carcinoma and beyond.* Note: Hepatic lobectomy is indicated for the gall bladder carcinoma with local infiltration in the liver tissue. This comes under T3 in the TNM classification. Such patients are not included in the sage of gall bladder carcinoma <stage IIA. Thus resection of hepatic lobe for operable cases of gall bladder carcinoma can only be considered from / beyond stage IIA of gall bladder carcinoma. Gall bladder cancer for most patients is a lethal disease with a grim prognosis. The median survival is less than six months and a five-year survival figure of 5 per cent reported.
IA
IIA
III
IV
Gall Bladder & Bile Ducts