Categorization of Tumor and Nodal Status for Gallbladder Carcinoma in the Era of Minimally Invasive Radical Cholecystectomy

Abstract The American Joint Committee on Cancer panel has updated its tumor, node, and metastasis staging guidelines for gallbladder carcinoma in the last eighth edition. The most significant developments were the introduction of a new definition for the T2 stage and the quantification of N staging. This revision was based on a multi-institutional retrospective analysis. Although the category T2a has some prognostic significance, it is not particularly useful from a management perspective, especially in the era of minimally invasive radical cholecystectomy. Likewise, while converting N status into quantitative figures seems reasonable, the extent of radical lymphadenectomy remains unclear. After its implementation, several authors have examined the clinical implications and validation of this new staging system, though with mixed results. We reviewed the various validation studies to assess the impact of changes in the staging system and addressed concerns about its practical application and potential pitfalls.