In most cases an immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is needed. The S3 guidelines valid till 2015 have recommended IRR in T2 and more advanced stages. The new S3- guidelines will recommend more aggressive surgery even in T1b, due to German- Registry (GR) data. According to the data of the GR the indication for IRR depends more on the experience of the hospitals in liver surgery than on complying with the guidelines, so most of IGBC- patients are staged incorrectly and not treated oncological sufficient. In practice, the following questions are of interest. Depends treatment of IGBC on the surgical or oncological expertise of the clinics? Which technique of liver resection (LR) is meaningful in which stage? What is important regarding lymph node ratio (LNR). What's about multimodal aspects.
For data analysis we used the GR. The GR includes more than 1000 cases of IGBC and is the largest gbc registry in Europe.
To date more than 950 cases of IGBC in the GR have been analyzed. In 42 of 113 T1b cases there was an IRR, with a significant survival benefit for T1b after IRR. There was also a significant survival benefit for the 228 T2 and 80 T3 with IRR of the 461 T2 and 215 T3 tumors. Comparison of LR showed good results for the wedge resection technique (WRT) in T1b and T2. For T3 more radical techniques showed better results. Less than 50% of T2–3 tumors in the registry have been re-resected. LR was performed significantly more often in High- volume (HV) clinics. In 212 patients the LNR could be calculated. Statistic showed that LNR is a significant prognostic factor. The results show that the referral of patients from a LV to a HV has no practical relevance.
IGBC's up to T1b needs radical surgery. WRT is an attractive procedure for T1b / T2 IGBC due to the lower invasiveness and implantation should also be possible in LV's with few experience in liver surgery. Also the count of retrieved lymph nodes is of essential interest. By following the correct decision processes more patients have the possibility for cure. For further increasing the cure rate in T2-3 GBC patients a multimodal therapy trial has been planned by the investigator supported by of more than 300 clinics.
Clinical trial identification
The German Registry
Legal entity responsible for the study
The German- registry/ no commercial founding Part of UCT (University Cancer Center Frankfurt)
All authors have declared no conflicts of interest.