The Immediate Re- Resection of T1b Incidental Gallbladder Carcinoma- Indication or Overtreatment

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.
A 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. Some authors show a 5 year survival of only 37.5- 68% in T1b- carcinomas after simple Cholecystectomie. Therefore some authors recommend a reoperation in 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.
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: 606 cases of incidental gallbladder carcinomas are registered. In 21 patients with T1a- tumour there was no IRR, in 6 patients there was an IRR. In 50 patients with T1b- tumour there was no IRR. In 26 patients with T1- tumour there was an IRR. The survival curve according to Kaplan- Meier shows a significant prognostic advantage for re- resected T1b- tumours. In cases of T1a there is no prognostic benefit for patients with an IRR. The IRR includes a lymph- node dissection of hepatoduodenal ligament. The liverresection technique was 12 x wedge- resection, 5 x a resection of Segemt IVb/V and in 8 cases other techniques have been performed. There is a trend for a better survival for the wedge- resection technique compared with the other types of resection in cases of T1b- tumours.
Discussion: There is a significant survival benefit for the T1b tumours after an IRR (log- rank < 0,05). The analysis shows no advantage for T1a carcinomas after IRR. An IRR should be highly recommended for patients with IGBC in the T1b stage. There is a trend for a better survival for the wedge- resection technique compared with the other types of resection in cases of T1b- tumours. An extended resection is also necessary in order to exactly determine the nodal status.

Session: Podium Presentation

Program Number: S100