[Immediate radical re-resection of incidental T1b âgallbladder cancer and the problem of an adequate extent of resection (results of the German Registry "Incidental Gallbladder Cancer")]. / Die unmittelbare radikale Re-Operation bei inzidentellem T1b-Gallenblasenkarzinom und die Frage der angemessenen Radikalität (CAESâ/âCAMIC-Zentralregister: "Okkultes Gallenblasenkarzinom").
Zentralbl Chir
; 139 Suppl 2: e43-8, 2014 Dec.
Article
em De
| MEDLINE
| ID: mdl-21365537
ABSTRACT
INTRODUCTION:
Gallbladder cancer is suspected preoperatively in only 30â% of all patients, while the other 70â% of cases are discovered incidentally by the pathologist (incidental or occult gallbladder cancer or IGBC). If gallbladder cancer is suspected preoperatively, an open cholecystectomy must be performed. The increasing rate of cholecystectomies via laparoscopy has lad to the detection of more gallbladder cancers in an early stage. Extended resection with regional lymph node dissection for T2âcarcinomas and for more advanced cancer has been suggested. If IGBC is detected postoperatively by the pathologist after simple cholecystectomy, radical re-resection in cases of T2âtumours and more advanced stages is recommended. However, it has been argued that T1bâcancers may have spread regionally or systemically at presentation and, thus, it remains debatable whether T1bâcancers should be treated by simple cholecystectomy or by radical resection. PATIENTSâ/âMATERIAL ANDMETHOD:
This investigation was based on the German Registry of "Incidental Gallbladder Cancer" of the German Society of Surgery. In the present study, we evaluated whether T1âcarcinoma patients do profit from a radical re-resection and if the different techniques of liver resection have comparable results in T1âcarcinomas.RESULTS:
We analysed 684âcases of IGBC including 124âpatients with T1âcancer with a 5-year survival of 48â%. An extended re-resection increased the 5-year survival up to 68â% for T1-IGBC. The analysis shows no advantage for re-resection of T1aâcancer. In contrast, the current analysis shows a statistically significant survival benefit for re-resection of T1bâcancers from 34â% to 75â%. The Registry data show a trend of better survival for the patients treated with the wedge resection technique compared to other resection techniques.CONCLUSION:
For T1aâcancer a simple cholecystectomy is sufficient. An immediate re-resection is highly recommended for patients with IGBC in T1bâstage. The wedge resection technique combined with a locoregional lymphadenectomy of the hepatoduodenal ligament seems to be the strategy of choice for T1bâcancer. An extended re-resection is necessary to determine the nodal status exactly, and to determine an exact definite staging for patients with T1bâcancer.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Diagnostic_studies
Limite:
Aged
/
Female
/
Humans
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Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
De
Ano de publicação:
2014
Tipo de documento:
Article