title: Key factors influencing prognosis in relation to gallbladder cancer.
abstract: BACKGROUND
  The 5-year survival of patients with gallbladder cancer remains low. However, patients can be stratified into prognostic categories based on established factors such as T, N, and R status. New concepts regarding prognostic significance of lymph node disease, the importance of residual gallbladder fossa disease, and the gravity of presentation with jaundice are reviewed. In addition, a number of new prognostic factors proposed in recent years are considered.
  
  
  METHODS
  PubMed was searched for "gallbladder cancer" with builder "date-completion" 2008 to present. A total of 1,490 articles were screened from which 168 were retrieved. From this, 40 articles specifically related to prognosis form the basis for this review.
  
  
  CONCLUSIONS
  Key factors of prognostic significance remain T and N stage and R0 resection. Residual disease either in the gallbladder fossa, lymph nodes, or cystic duct margin dictates hepatectomy, lymphadenectomy and bile duct resection, respectively. Adequate lymphadenectomy requires removal of six nodes, and hepatectomy must be sufficient to achieve R0. Subtleties regarding lymph node ratio, significance of pathological features such as dedifferentiation, and budding may hold value for stratifying patients with early stage disease, but require further investigation.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA. charlespilgrim@hotmail.com
authors.forename: Charles Henry Caldow
authors.initials: CH
authors.lastname: Pilgrim
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Groeschl
authors.forename: Kiran K
authors.initials: KK
authors.lastname: Turaga
authors.forename: T Clark
authors.initials: TC
authors.lastname: Gamblin
mesh_terms: D001652:Bile Ducts / Q000601:surgery; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D007565:Jaundice / Q000209:etiology; D008207:Lymphatic Metastasis; D011379:Prognosis; D012086:Reoperation