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WHICH PATIENTS WITH GALL BLADDER CANCER ARE LIKELY TO SURVIVE LONG?
Vinay Kapoor^*, Gaurav Singh, Anu Behari, Anand Prakash, Rajneesh K. Singh, Ashok Kumar, Rajan Saxena
SGPGIMS, Lucknow, India

Gall bladder cancer (GBC) is associated with poor long term survival even after surgical resection. We analyzed our prospectively maintained database to find out which patients with GBC are likely to survive long (>5 years). Between 1989 and 2011, 910 patients with GBC were operated - non-resectional procedures viz. laparoscopy, laparotomy and bypass 473, non-curative resectional procedures 89 and resection with intent to cure 347 (cholecystectomy 142, extended cholecystectomy 192, major hepatectomy 13); 12 (3.5%) out of these 347 patients died in the hospital and 335 were discharged from the hospital. 100 of these 335 patients were lost to follow up (follow up <2 years) and 41 had incomplete follow up (2-5 years). Complete follow up i.e. either death at any time or long term (>5 years) survival was available in 194 out of 335 patients. These 194 patients who underwent resection with intent to cure and in whom complete follow up was available were part of this analysis; 78 long term survivors who survived for >5 years were compared with 116 short term survivors i.e. those who died before 5 years (Table).
Patients who do not have a palpable GB mass or jaundice, those with tumor in GB fundus/ body (cf. GB neck), those with T1/T2 (cf. T3), N0 (cf. N1 or NX) and TNM stage I (cf. II/III) disease, those who do not require CBD excision, those who undergo radical surgery, those in whom R0 resection status is achieved and those with LN yield >3 are more likely to survive for >5 years. Patients who require CBD excision, those who have R1 resection with T4, N2, M1, TNM stage IV tumor are unlikely to survive for >5 years.

Long term (>5 years) survival in 194 patients with gall bladder cancer who underwent resection with intent to cute and in whom complete follow up is available

		Survival >5 years
Overall		78/194 (40%)
GB mass	palpable	17/60 (28%)	significant
	not palpable	61/134 (46%)
Jaundice	present	11/33 (33%)	significant
	absent	67/161 (42%)
Type of surgery	radical	51/117 (44%)	significant
	non-radical	27/77 (35%)
CBD excision	yes	4/26 (15%)	significant
	no	74/168 (44%)
Resection status	R0	55/117 (47%)	significant
	R1	1/11 (9%)
Location of tumor	GB fundus/ body	49/106 (46%)	significant
	GB neck	7/26 (27%)
T status	T1	20/29 (69%)	significant
	T2	41/86 (48%)
	T3	17/75 (23%)
	T4	0/4 (0%)
N status	N0	53/ 88 (60%)	significant
	N1	13/51 (25%)
	N2	0/15 (0%)
	NX	12/40 (30%)
TNM stage	I	20/28 (71%)	significant
	II	28/60 (47%)
	IIIa	15/35 (43%)
	IIIb	13/49 (27%)
	IV	1/22 (5%)
LN yield	<3	10/37 (27%)	significant
	>3	41/75 (55%)

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