The immediate re- resection of T1 incidental gallbladder carcinoma- indication or over treatment

Introduction: The indication for an immediate re-resection (IRR) in T1b incidental gallbladder carcinoma (IGBC) is debated in the literature, and different recommendations are often drawn based on data collected from only small groups. But the management of IGBC is difficult, because there are no established guidelines.
An IRR is recommended in cases of T2 tumours and more advanced stages according to many authors and the effective guidelines in of Germany.For a T1 tumour a simple cholecystectomy is enough.The IRR includes a liver resection and a loco regional lymphadenectomy. In which T- stage such a re- resection should be undertaken is debated in the international literature.
Some authors recommend a re resection in case of T1b- stage and improve the 5 year survival from 60 to 100%, because the rate of positive lymph nodes is up to 16% and the lymphatic, venous and perineural infiltration is up to 50% according to the literature.
Others recommend a reoperation only when the margins are positive or when there is subserosal invasion > 2mm.
The question is, if T1b tumours do profit from a re- resection or if this operation is only an additional lethality, the same question has to be discussed for T3 and T4 tumours.
Material and method: To obtain data we use the German- Registry of incidental gallbladder carcinoma, which is institution of the German Society of Surgery.Within a period of 3 months we are actualizing the data.
Results: 550 cases of incidental gallbladder carcinomas are registered.
In 79 patients with T1- tumour there was no IRR.In 31 patients with T1- tumour there was an IRR. According to Kaplan- Meier graph for T1- tumours,there is a significant prognostic advantage for T1- tumours with an IRR.
In 138 patients with T2- tumours there was no IRR.In 117 patients with T2- tumour there was an IRR. According to Kaplan- Meier for T2- tumours there is a significant prognostic advantage for T2- tumours with IRR.
The Kaplan- Meier graphs for T3 and T4- tumours indicate no survival benefit after IRR.
Discussion: There is a significant survival benefit for the T2 tumours and T1b- tumours after an IRR (log- rank < 0,05). The analysis shows no advantage for T1a and T3/4 carcinomas after IRR. An IRR should be highly recommended for patients with IGBC in the T1b stage. An extended resection is also necessary in order to exactly determine the nodal status, to make an exact definite staging for these patients, and to separate nodal negative patients (Stage Ia, IIb) from those with positive lymph-nodes.

Session: Podium Presentation

Program Number: S113

« Return to SAGES 2008 abstract archive