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Surgical Endoscopy

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01-11-2008

Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry

Authors: T. O. Goetze, V. Paolucci

Published in: Surgical Endoscopy | Issue 11/2008

Abstract

Background

Incidental gallbladder carcinoma (IGBC) is a carcinoma first detected by the pathologist. The indication for cholecystectomy is a benign disease. The indication for immediate re-resection (IRR) in the case of T1b incidental gallbladder carcinoma (IGBC) is debated in the literature, and different recommendations often are drawn on the basis of data collected from only small groups. However, the management of IGBC is difficult because no guidelines have been established. This study aimed to determine whether T1b IGBC actually benefits from an IRR.

Methods

A registry was founded in 1997 for prospective recording of all IGBCs in Germany. All the patients who had a re-resection in this study were treated according to the effective guidelines in Germany. This study analyzes 502 cases of IGBC. Kaplan-Meier curves were used to determine whether an IRR improves the survival of patients with T1 and T1b IGBC.

Results

No benefit was found for 5 of the 21 T1a patients who had an IRR, but 23 of the 72 T1b patients who had an IRR experienced a significant benefit. The rate of tumor recurrence was three times lower in the T1b group that underwent IRR.

Conclusion

An IRR should be highly recommended for patients with IGBC in the T1b stage.

Varshney S, Buttirini G, Gupta R (2002) Incidental carcinoma of the gallbladder. Eur J Surg Oncol 28:4–10PubMedCrossRef

Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT (2002) Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer? Surg Endosc 16(5):828–832PubMedCrossRef

Benoist S, Panis Y, Fagniez PL (1998) Long-term results after curative resection for carcinoma of the gallbladder. Am J Surg 175:118–122PubMedCrossRef

Misra MC, Guleria S (2006) Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol 93:690–698PubMedCrossRef

Romano F, Franciosi C, Caprotti R, De Fina S, Porta G, Visintini G, Uggeri F (2001) Laparoscopic cholecystectomy and unsuspected gallbladder cancer. Eur J Surg Oncol 27(3):225–228PubMedCrossRef

Toyonaga T, Chijiiwa K, Nakano K, Noshiro H, Yamaouchi K, Sada M, Terasaka R, Konomi K, Nishikata F, Tanaka M (2003) Completion radical surgery after cholecystectomy for accidentally undiagnosed gallbladder carcinoma. World J Surg 27(3):266–271PubMedCrossRef

Shimizu T, Arima Y, Yokomuro S, Yoshida H, Mamada Y, Nomura T, Taniai N, Aimoto T, Nakamura Y, Mizuguchi Y, Kawahlgashi Y, Uchida E, Akimaru K, Tajiri T (2006) Incidental gallbladder cancer diagnosed during and after laparoscopic cholecystectomy. J Nippon Med Sch 73(3):136–140PubMedCrossRef

Lammert F, Neubrand MW, Bittner R, Feussner H, Greiner L, Hagenmüller F, Kiehne KH, Ludwig K, Neuhaus H, Paumgartner G, Riemann JF, Sauerbruch T; Deutschen Gesellschaft für Verdauungs- und Stoffwechselkrankheiten; Deutschen Gesellschaft für Viszeralchirurgie zur Diagnostik und Behandlung von Gallensteinen (2007) S3-Guidelines for Diagnosis and Treatment of Gallstones. German Society for Digestive and Metabolic Diseases and German Society for Surgery of the Alimentary Tract. Z Gastroenterol 45(9): 971–1001

Shirai Y, Yoshida K, Tsukada K, Muto T (1992) Inapparent carcinoma of the gallbladder: an appraisal of a radical second operation after simple cholecystectomy. Ann Surg 215(4):326–331PubMedCrossRef

10.

Fong Y, Jarnagin W, Blumgart LH (2000) Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg 232:557–569PubMedCrossRef

11.

Ouchi K, Owada Y, Matsuno S, Sato T (1987) Prognostic factors in the surgical treatment of gallbladder carcinoma. Surgery 101(6):731–737PubMed

12.

Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K (2000) Regional and para-aortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 87(4):418–422PubMedCrossRef

13.

Endo I, Shimada H, Takimoto A, Fujii Y, Miura Y, Sugita M, Morioka D, Masunari H, Tanaka K, Sekido H, Togo S (2004) Microscopic liver metastasis: prognostic factor for patients with pT2 gallbladder carcinoma. World J Surg 28(7):692–696PubMedCrossRef

14.

Puhalla H, Wild T, Bareck E, Pokorny H, Pioner M, Soliman T, Stremitzer S, Depisch D, Laengle F Gruenberger T (2002) Long-term follow-up of surgically treated gallbladder cancer patients. Eur J Surg Oncol 28(8):857–863PubMedCrossRef

15.

Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H (1992) Radical surgery for gallbladder carcinoma: long-term results. Ann Surg 216(5):565–568PubMedCrossRef

16.

Bartlett DL, Fong Y, Fortner JG, Brennan MF, Blumgart LH (1996) Long-term results after resection for gallbladder cancer: implications for staging and management. Ann Surg 224(5):639–646PubMedCrossRef

17.

Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, Tanaka M (2001) Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg 192(5):600–607PubMedCrossRef

18.

Yamaguchi K, Chijiiwa K, Ichimiya H, Sada M, Kawakami K, Nishikata F, Konomi K, Tanaka M, (1996) Gallbladder carcinoma in the era of laparoscopic cholecystectomy. Arch Surg 131(9):981–985PubMed

19.

Wakai T, Shirai Y, Yokoyama N, Nagakura S, Watanabe H, Hatakeyama K (2001) Early gallbladder carcinoma does not warrant radical resection. Br J Surg 88(5):675– 78PubMedCrossRef

20.

Tsunoda T, Tsuchiya R, Harada N, Izawa K, Yamaguchi T, Yamamoto K, Motoshima K, Tomioka T, Matsuo S, Eto T (1987) The surgical treatment for carcinoma of the gallbladder: rationale of the second-look operation for inapparent carcinoma. Jpn J Surg 17(6):478–486PubMedCrossRef

21.

Steinert R, Nestler G, Sagynaliev E, Müller J, Lippert H, Reymond MA (2006) Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 93(8):682–689PubMedCrossRef

22.

Otero JC, Proske A, Vallilengua C, Luján M, Poletto L, Pezzotto SM, Fein L, Otero JR, Celoria G (2006) Gallbladder cancer: surgical results after cholecystectomy in 25 patients with lamina propria invasion and 26 patients with muscular layer invasion. J Hepatobiliary Pancreat Surg 13(6):562–566PubMedCrossRef

23.

Sikora SS, Singh RK (2006) Surgical strategies in patients with gallbladder cancer: nihilism to optimism. J Surg Oncol 93:670–681PubMedCrossRef

Title: Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry
Authors: T. O. Goetze
V. Paolucci
Publication date: 01-11-2008
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 11/2008
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-008-9747-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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