The perforation of the GB in cases of incidental GB cancer: Indication for the use of retrieval bags?

Introduction: The accidental intraoperative perforation of the gallbladder is a problem of the laparoscopic surgery, if an incidental gallbladder carcinoma exists at the time of operation.
According to the literature this complication comes up to 30% of the laparoscopic operations.
In order to prevent the dissemination of tumour cells the use of an isolation bag is proclaimed.
The question is if the intraoperative perforation of gallbladder carcinoma really leads to a prognostic deterioration and if the patients which have been treated with an isolation bag have an prognostic advantage.
Material and method: To obtain data we are using the data of the German- registry of incidental gallbladder carcinoma, which is supported by the German Society of Surgery.
We are collecting our data with a standarized questionaire, which has been sent to all german and now to all austrian surgical clinics as well.
In a period of 3 months we are actualizing the data.
Results: 606 cases of incidental gallbladder carcinomas are registered.
335 were operated laparoscopically, 105(31.3%) of them get a relapse of the tumour.
180 patients were treated with the support of an isolation bag, the rate of a relapse was 35% (n= 63).
155 of the laparoscopic group have treated without a isolation bag, the rate of an relapse was 27% (n= 42).
In 73 of 335 laparoscopic treated patients there was an intraoperative accidental opening of the organ, the rate of a relapse was 39.7% (n= 29).
In 51 of 73 cases an isolation bag was used, the rate of a relapse was 41.2% (n= 21).
The other 22 of 73 patients who were operated without an isolation bag have a rate of relapse of 36.4%(n=8).
The group without an intraoperative perforation (n= 262) have 29.0% (n=76) of tumour reccurence.
129 of this 262 were treated with the use of an isolation bag, 42 (32.6%) of them had a tumour reccurence, the other 133 of the 262 patients treated without a bag had a recurrence rate of 25.6% (n= 34).
Discussion: In our registry, the intraoperative perforation leads to a significant prognostic disadvantage(p=0.046 Fisher`s exact test).
The patients treated with an isolation bag have a tendency of a higher rate of tumour recurrences (p= 0,055 Fisher`s exact test), but the isolation bag was used significantly more often in cases of gallbladder perforation, nevertheless the recurrence rate is higher in patients without a intraoperativ perforation treated with the use of an isolation bag compared with those treated without a bag. The reasons therefore have to be discussed.

Session: Poster

Program Number: P489

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