Goetze Thorsten Oliver, Paolucci Vittorio
Department of Surgery, Ketteler-Krankenhaus, Offenbach, Germany.
Ann Surg. 2008 Jan;247(1):104-8. doi: 10.1097/SLA.0b013e318154bf5d.
The aim of this study was to determine which T stages of incidental gallbladder carcinoma (IGBC) actually benefit from an early reresection (ERR).
The IGBC is a carcinoma first detected by the pathologist. The indication for the cholecystectomy was a benign disease. The indication for an ERR is debated in the literature, and different recommendations are often drawn based on data collected from only small groups.
A register was founded in 1997 to prospectively record all IGBCs in Germany. All the patients who had a reresection in this study were treated according to the German Guidelines of Surgery and Oncology. This study analyzes 439 cases of IGBC.
There was a significant benefit for the 85 of 200 T2 patients who did have an ERR. There was no benefit though for the 32 of 85 T3 patients who did have an ERR. There is a significantly better survival rate for T2 patients with negative lymph nodes, and there is a trend for better survival for T3 patients with negative lymph nodes.
An ERR should be highly recommended for patients with IGBC in the T2 stage, because it improves their survival positive. Without an ERR, it is almost impossible to definitively determine the nodal status or to obtain exact staging for estimating the prognosis.
本研究旨在确定意外胆囊癌（IGBC）的哪些T分期患者实际能从早期再次手术（ERR）中获益。
IGBC是一种首先由病理学家检测到的癌症。胆囊切除术的指征是良性疾病。ERR的指征在文献中存在争议，并且常常基于仅从小规模组收集的数据得出不同的建议。
1997年建立了一个登记册，前瞻性记录德国所有的IGBC病例。本研究中所有接受再次手术的患者均按照德国外科和肿瘤学指南进行治疗。本研究分析了439例IGBC病例。
200例T2期患者中有85例接受了ERR，这部分患者有显著获益。然而，85例T3期患者中有32例接受了ERR，但并未从中获益。T2期淋巴结阴性患者的生存率明显更高，T3期淋巴结阴性患者也有生存改善的趋势。
对于T2期IGBC患者应强烈推荐进行ERR，因为这能提高他们的生存率。如果不进行ERR，几乎不可能明确确定淋巴结状态或获得准确分期以评估预后。
