Department of Surgery, Ketteler-Krankenhaus, Offenbach am Main, Germany.
Surg Endosc. 2010 Sep;24(9):2156-64. doi: 10.1007/s00464-010-0914-4. Epub 2010 Feb 23.
Complete surgical resection is the only potentially curative treatment of gallbladder cancer. Gallbladder carcinoma is suspected preoperatively in 30% of patients, and 70% are incidentally discovered by the pathologist (incidental gallbladder carcinoma, IGBC). If IGBC is detected postoperatively, a re-resection, including liver resection and lymph node dissection, in T2 tumor cases and more advanced stages is recommended. It remains unclear whether the prognosis of wedge resection (2-3-cm margin) of the gallbladder bed is the same as that of resection of segments IVb/V.
The German Registry, founded in 1997, aims to prospectively record all IGBC cases in Germany. In this study patients with a radical re-resection were treated according to the S3 Guidelines in Germany. The aim of this study was to clarify whether different techniques of liver re-resection show comparable results or if they differ depending on the tumor stage in IGBC patients (n = 624).
A significant survival advantage in patients who have an early re-resection was observed. There was a trend of better survival in T1 tumor stage patients who undergo the less radical re-resection, especially the wedge-resection technique of 3 cm in the gallbladder bed. In T2 tumor stage patients there is a tendency for better survival with the IVb/V-resection technique compared to the 3-cm wedge resection in the gallbladder bed, and a significant survival benefit for these two techniques compared to less radical resection was evident. T3 tumor cases showed better survival with the more radical resection techniques.
The wedge-resection technique combined with lymph node dissection may be the surgical strategy of choice in T1 tumor cases. For T2 tumors, IVb/V resection combined with lymph node dissection of the hepatoduodenal ligament appears to be the minimum volume of resection required. More radical procedures are needed for tumors infiltrating the serosa or beyond.
彻底的手术切除是治疗胆囊癌的唯一潜在治愈方法。术前约 30%的患者怀疑患有胆囊癌，70%的患者是由病理学家偶然发现的（偶发性胆囊癌，IGBC）。如果术后发现 IGBC，建议对 T2 肿瘤病例和更晚期病例进行再次切除，包括肝切除和淋巴结清扫。对于胆囊床的楔形切除术（2-3cm 切缘）与 IVb/V 段切除术的预后是否相同，目前仍不清楚。
德国注册处成立于 1997 年，旨在前瞻性地记录德国所有 IGBC 病例。在这项研究中，接受根治性再次切除的患者按照德国 S3 指南进行治疗。本研究旨在阐明 IGBC 患者（n=624）的不同肝再次切除技术是否具有可比的结果，或者它们是否因肿瘤分期而异。
早期再次切除的患者有显著的生存优势。在 T1 肿瘤分期的患者中，接受较不激进的再次切除（尤其是胆囊床 3cm 的楔形切除术）的患者，生存趋势较好。在 T2 肿瘤分期的患者中，与胆囊床 3cm 楔形切除术相比，IVb/V 切除术有更好的生存趋势，与较不激进的切除相比，这两种技术有明显的生存获益。T3 肿瘤病例的更激进切除技术有更好的生存结果。
楔形切除术联合淋巴结清扫术可能是 T1 肿瘤病例的首选手术策略。对于 T2 肿瘤，IVb/V 切除联合肝十二指肠韧带淋巴结清扫似乎是必需的最小切除量。对于浸润浆膜或更远处的肿瘤，需要更激进的手术。
