Surgical Endoscopy

, Volume 24, Issue 9, pp 2156–2164 | Cite as

Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry

  • Thorsten Oliver GoetzeEmail author
  • Vittorio Paolucci



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.


Pancreatobilio Cholecystectomy Gallbladder carcinoma Surgical Technical 




Authors Thorsten Oliver Goetze and Vittorio Paolucci have no conflicts of interest of financial ties to disclose.


  1. 1.
    Varshney S, Buttirini G, Gupta R (2002) Incidental carcinoma of the gallbladder. Eur J Surg Oncol 28:4–10CrossRefPubMedGoogle Scholar
  2. 2.
    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 16:828–832CrossRefPubMedGoogle Scholar
  3. 3.
    Benoist S, Panis Y, Fagniez PL (1998) Long-term results after curative resection for carcinoma of the gallbladder. Am J Surg 175:118–122CrossRefPubMedGoogle Scholar
  4. 4.
    Kohya N, Miyazaki K (2008) Hepatectomy of segment 4a and 5 combined with extra-hepatic bile duct resection for T2 and T3 gallbladder carcinoma. J Surg Oncol 97:498–502CrossRefPubMedGoogle Scholar
  5. 5.
    Shih SP, Schulick RD, Cameron JL, Lillemoe KD, Pitt HA, Choti MA, Campbell KA, Yeo CJ, Talamini MA (2007) Gallbladder cancer: the role of laparoscopy and radical resection. Ann Surg 245(6):893–901CrossRefPubMedGoogle Scholar
  6. 6.
    Henson DE, Albores-Saavedra J, Corle D (1992) Carcinoma of the extra hepatic bile ducts. Histologic types, stage of disease, grade, and survival rates. Cancer 70:1498–1501CrossRefPubMedGoogle Scholar
  7. 7.
    Henson DE, Albores-Saavedra J, Corle D (1992) Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates. Cancer 70:1493–1497CrossRefPubMedGoogle Scholar
  8. 8.
    Nimura Y (2002) Extended surgery in bilio-pancreatic cancer: the Japanese experience. Semin Oncol 29:17–22PubMedGoogle Scholar
  9. 9.
    Kondo S, Nimura Y, Kamiya J, Nagino M, Kanai M, Uesaka K, Yuasa N, Sano T, Hayakawa N (2001) Five-year survivors after aggressive surgery for stage IV gallbladder cancer. J Hepatobiliary Pancreat Surg 8:511–517CrossRefPubMedGoogle Scholar
  10. 10.
    Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K (2002) Extensive surgery for carcinoma of the gallbladder. Br J Surg 89:179–184PubMedGoogle Scholar
  11. 11.
    Kondo S, Nimura Y, Hayakawa N, Kamiya J, Nagino M, Uesaka K (2000) Regional and paraortic lymphadenectomy in radical surgery for advanced gallbladder carcinoma. Br J Surg 87:418–422CrossRefPubMedGoogle Scholar
  12. 12.
    Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H (1992) Radical surgery for gallbladder carcinoma: long-term results. Ann Surg 216:565–568CrossRefPubMedGoogle Scholar
  13. 13.
    Shirai Y, Ohtani T, Tsukada K, Hatakeyama K (1997) Radical surgery is justified for locally advanced gallbladder carcinoma if complete resection is feasible. Am J Gastroenterol 92:181–182PubMedGoogle Scholar
  14. 14.
    Todoroki T, Kawamoto T, Takahashi H, Takada Y, Koike N, Otsuka M, Fukao K (1999) Treatment of gallbladder cancer by radical resection. Br J Surg 86:622–627CrossRefPubMedGoogle Scholar
  15. 15.
    Todoroki T, Takahashi H, Koike N, Kawamoto T, Kondo T, Yoshida S, Kashiwagi H, Otsuka M, Fukao K, Saida Y (1999) Outcomes of aggressive treatment of stage IV gallbladder cancer and predictors of survival. Hepatogastroenterology 46:2114–2121PubMedGoogle Scholar
  16. 16.
    Box JC, Edge SB (1999) Laparoscopic cholecystectomy and unsuspected gallbladder carcinoma. Semin Surg Oncol 16:327–331CrossRefPubMedGoogle Scholar
  17. 17.
    Copher JC, Rogers JJ, Dalton ML (1995) Trocar-site metastasis following laparoscopic cholecystectomy for unsuspected carcinoma of the gallbladder. Surg Endosc 9:348–350CrossRefPubMedGoogle Scholar
  18. 18.
    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 27:225–228CrossRefPubMedGoogle Scholar
  19. 19.
    Toyonaga T, Chijiiwa K, Nakano K, Noshiro H, Yamaguchi 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 27:266–271CrossRefPubMedGoogle Scholar
  20. 20.
    Wakai T, Shirai Y, Hatakeyama K (2002) Radical second resection provides survival benefit with T2 gallbladder carcinoma first discovered after laparoscopic cholecystectomy. World J Surg 26:867–871CrossRefPubMedGoogle Scholar
  21. 21.
    Ouchi K, Mikuni J, Kakugawa Y, Organizing Committee, the 30th Annual Congress of the Japanese Society of Biliary Surgery (2002) Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg 9:256-260Google Scholar
  22. 22.
    Weiland ST, Mahvi DM, Niederhuber JE, Heisey DM, Chicks DS, Rikkers LF (2002) Should suspected early gallbladder cancer be treated laparoscopically? J Gastrointest Surg 6:50–56CrossRefPubMedGoogle Scholar
  23. 23.
    Braghetto I, Bastias J, Csendes A, Chiong H, Compan A, Valladares H, Rojas J (1999) Gallbladder carcinoma during laparoscopic cholecystectomy: Is it associated with bad prognosis? Int Surg 84:344–349PubMedGoogle Scholar
  24. 24.
    Goetze T, Paolucci V (2006) Does laparoscopy worsen the prognosis for incidental gallbladder cancer? Surg Endosc 20(2):286–293CrossRefPubMedGoogle Scholar
  25. 25.
    Cucinotta E, Lorenzini C, Melita G, Iapichino G, Curro G (2005) Incidental gallbladder carcinoma: does the surgical approach influence the outcome? ANZ J Surg 75:795–798CrossRefPubMedGoogle Scholar
  26. 26.
    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 232:557–569CrossRefPubMedGoogle Scholar
  27. 27.
    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 215:326–331CrossRefPubMedGoogle Scholar
  28. 28.
    Ouchi K, Owada Y, Matsuno S, Sato T (1987) Prognostic factors in the surgical treatment of gallbladder carcinoma. Surgery 101:731–737PubMedGoogle Scholar
  29. 29.
    Ogura Y, Mizumoto R, Isaji S, Kusuda T, Matsuda S, Tabata M (1991) Radical operations for carcinoma of the gallbladder: present status in Japan. World J Surg 15:337–343CrossRefPubMedGoogle Scholar
  30. 30.
    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):971-1001Google Scholar
  31. 31.
    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 4:692–696Google Scholar
  32. 32.
    Wanebo HJ, Vezeridis MP (1993) Carcinoma of the gallbladder. J Surg Oncol 3:134–139CrossRefGoogle Scholar
  33. 33.
    De Vita VII, Hellman S, Rosenberg S (2004) Cancer: principles and practice of oncology, 7th edn. Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  34. 34.
    Misra MC, Guleria S (2006) Management of cancer gallbladder found as a surprise on a resected gallbladder specimen. J Surg Oncol 93:690–698CrossRefPubMedGoogle Scholar
  35. 35.
    Schumpelick V, Manegold BC, Paolucci V (1997) Zentralregister “laparoskopische Tumordissemination und Portmetastasen”. Dtsch Gesellsch Chirurg Mitt 2:133Google Scholar
  36. 36.
    Glenn F, Hays DM (1954) The scope of radical surgery in the treatment of malignant tumors of the extrahepatic biliary tract. Surg Gynecol Obstet 99:529–541PubMedGoogle Scholar
  37. 37.
    Fahim RB, McDonald JR, Richards JC, Ferris DO (1962) Carcinoma of the gallbladder: a study of its modes of spread. Ann Surg 156:114–124CrossRefPubMedGoogle Scholar
  38. 38.
    Kinoshita H, Hashino K, Hashimoto M, Kodama T, Nishimura K, Kawabata M, Furukawa S, Tamae T, Nagashima J, Hara M, Imayama H, Aoyagi S (2001) Clinicopathological evaluation of surgical treatment for early gallbladder cancer. Kurume Med J 48:267–271PubMedGoogle Scholar
  39. 39.
    Mizumoto R, Ogura Y, Matsuda S et al (1990) Cooperative survey of surgical treatment for carcinoma of the biliary tract in Japan. Tan to Sui 11:869–882Google Scholar
  40. 40.
    You DD, Lee HG, Paik KY, Heo JS, Choi SH, Choi DW (2008) What is an adequate extent of resection for T1 gallbladder cancers? Ann Surg 247(5):835–838CrossRefPubMedGoogle Scholar
  41. 41.
    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 224:639–646CrossRefPubMedGoogle Scholar
  42. 42.
    Ito H, Matros E, Brooks DC, Osteen RT, Zinner MJ, Swanson RS, Ashley SW, Whang EE (2004) Treatment outcomes associated with surgery for gallbladder cancer: a 20 year experience. J Gastrointest Surg 8(2):183–190CrossRefPubMedGoogle Scholar
  43. 43.
    Ishikawa T, Horimi T, Shima Y, Okabayashi T, Nishioka Y, Hamada M, Ichikawa J, Tsuji A, Takamatsu M, Morita S (2003) Evaluation of aggressive surgical treatment for advanced carcinoma of the gallbladder. J Hepatobiliary Pancreat Surg 10(3):233–238CrossRefPubMedGoogle Scholar
  44. 44.
    Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H (2004) Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol 30(8):842–846PubMedGoogle Scholar
  45. 45.
    Behari A, Sikora SS, Wagholikar GD, Kumar A, Saxena R, Kapoor VK (2003) Long term survival after extended resections in patients with gallbladder cancer. J Am Coll Surg 196(1):82–88CrossRefPubMedGoogle Scholar
  46. 46.
    Chijiiwa K, Tanaka M (1994) Carcinoma of the gallbladder: an appraisal of surgical resection. Surgery 115:751–756PubMedGoogle Scholar
  47. 47.
    Miyazaki M, Itoh H, Ambiru S, Shimizu H, Togawa A, Gohchi E, Nakajima N, Suwa T (1996) Radical surgery for advanced gallbladder carcinoma. Br J Surg 83:478–481CrossRefPubMedGoogle Scholar
  48. 48.
    Tsukada K, Hatakeyama K, Kurosaki I, Uchida K, Shirai Y, Muto T, Yoshida K (1996) Outcome of radical surgery for carcinoma of the gallbladder according to the TNM stage. Surgery 120:816–821CrossRefPubMedGoogle Scholar
  49. 49.
    Cubertafond P, Gainant A, Cuchiaro G (1994) Surgical treatment of 724 carcinomas of the gallbladder. Results of the French Surgical Association Survey. Ann Surg 219:275–280CrossRefPubMedGoogle Scholar
  50. 50.
    Donohue JH, Stewart AK, Menck HR (1998) The national cancer data base report on carcinoma of the gallbladder, 1989–1995. Cancer 83:2618–2628CrossRefPubMedGoogle Scholar
  51. 51.
    Goetze TO, Paolucci V (2008) Benefits of reoperation of T2 and more advanced incidental gallbladder carcinoma: analysis of the German Registry. Ann Surg 247(1):104–108CrossRefPubMedGoogle Scholar
  52. 52.
    Goetze TO, Paolucci V (2008) Immediate re-resection of T1 incidental gallbladder carcinomas: a survival analysis of the German Registry. Surg Endosc 22(11):2462–2465CrossRefPubMedGoogle Scholar
  53. 53.
    Mekeel KL, Hemming AW (2007) Surgical management of gallbladder carcinoma: a review. J Gastrointest Surg 11(9):1188–1193CrossRefPubMedGoogle Scholar
  54. 54.
    Kai M, Chijiiwa K, Ohuchida J, Nagano M, Hiyoshi M, Kondo K (2007) A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg 11(8):1025–1032CrossRefPubMedGoogle Scholar
  55. 55.
    Reid KM, Ramos-De la Medina A, Donohue JH (2007) Diagnosis and surgical management of gallbladder cancer: a review. J Gastrointest Surg 11(5):671–681CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of SurgeryKetteler-KrankenhausOffenbach am MainGermany

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