Incidental T1b-T3 gallbladder carcinoma. Extended cholecystectomy as an underestimated prognostic factor-results of the German registry

• Published in: Chirurg Vol. 85; no. 2; pp. 131 - 138
• Main Authors: Goetze, T O, Paolucci, V
• Format: Journal Article
• Language: German
• Published: Germany 01-02-2014
• Subjects: Aged; Aged, 80 and over; Cholecystectomy - methods; Female; Gallbladder Neoplasms - mortality; Gallbladder Neoplasms - pathology; Gallbladder Neoplasms - surgery; Guideline Adherence; Hepatectomy - methods; Humans; Incidental Findings; Kaplan-Meier Estimate; Laparoscopy; Liver - pathology; Liver - surgery; Lymph Node Excision - methods; Lymph Nodes - pathology; Male; Middle Aged; Neoplasm Staging; Prognosis; Prospective Studies; Registries; Reoperation; Survival Rate
• DOI: 10.1007/s00104-013-2587-8
• EISSN: 1433-0385

The immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is debated in the literature. The German S3 guidelines recommend IRR in T2 and more advanced stages. Current literature recommends more extensive surgery even in T1b tumors.
The German registry database was used for this study.
To date 883 cases of IGBC have been analyzed. In 8 out of 39 patients with a T1a tumor IRR was carried out as well as in 43 out of 109 patients with a T1b tumor. There was a significant survival benefit for re-resected T1b patients. There was also a significant survival benefit for the 215 T2 tumors and the 75 T3 patients with IRR compared to the 441 T2 tumors and 207 T3 tumors without IRR. Comparison of liver resection techniques showed good results for the wedge resection technique in T1b and T2 carcinomas. For T3 carcinomas more radical techniques showed better results. Less than 50 % of T2-3 tumors in the registry have been re-resection.
The IRR should be highly recommended in patients with T1b and more advanced IGBC. The wedge resection technique is an attractive procedure for T1b and T2 IGBC due to the lower invasiveness in spite of oncological adequacy.