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Inzidentelle T1b- bis T3-Gallenblasenkarzinome

Die radikale Cholezystektomie als unterschätzter Prognosefaktor – Ergebnisse des CAES/CAMIC-Zentralregisters

Incidental T1b–T3 gallbladder carcinoma

Extended cholecystectomy as an underestimated prognostic factor—results of the German registry

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Zusammenfassung

Hintergrund

Die unmittelbare radikale Reoperation (RR) nach Cholezystektomie bei okkultem Gallenblasenkarzinom (OG) wird weiterhin kontrovers diskutiert. Ab einem T2-Stadium ist in den S3-Leitlinien eine RR vorgesehen. Die aktuelle Literatur empfiehlt dies bereits ab einem T1b-Stadium.

Material und Methoden

Als Datengrundlage diente das CAES/CAMIC-Zentralregister „Okkultes Gallenblasenkarzinom“.

Ergebnisse

Bis dato wurde 883 OG-Fälle statistisch ausgewertet. Bei 8 der 39 Patienten mit T1a-Tumor erfolgte eine RR. Bei 109 Patienten lag ein Stadium T1b vor, bei 43 davon erfolgte eine RR. Die Überlebenskurven zeigen einen signifikanten Vorteil für reoperierte T1b-Tumoren, nicht aber für T1a-Tumoren. Sowohl die 215 reoperierten T2-Tumoren der insgesamt 441 T2-Tumoren als auch die 75 reoperierten T3-Tumoren der insgesamt 207 T3-Tumoren zeigen einen signifikanten Überlebensvorteil für die radikal reserzierten Patienten. Der Vergleich der Leberresektionstechniken ergibt, dass die Wedge-Resektionstechnik eine attraktive Resektionsform sowohl für T1b- als auch T2-Tumoren darstellt. Für T3-Tumoren sind radikalere Verfahren erforderlich. Weniger als 50 % der T2-/T3-Tumor-Patienten aus dem Register erhielten eine RR.

Schlussfolgerung

Die Registerdaten zeigen einen signifikanten Überlebensbenefit für reoperierte Patienten ab einem Stadium T1b. Die Wedge-Resektionstechnik ist bezogen auf die Radikalität des Lebereingriffs beim T1b- und auch beim T2-Gallenblasenkarzinom ein attraktives Verfahren.

Abstract

Background

The immediate radical re-resection (IRR) after simple cholecystectomy in incidental gallbladder carcinoma (IGBC) is debated in the literature. The German S3 guidelines recommend IRR in T2 and more advanced stages. Current literature recommends more extensive surgery even in T1b tumors.

Methods

The German registry database was used for this study.

Results

To date 883 cases of IGBC have been analyzed. In 8 out of 39 patients with a T1a tumor IRR was carried out as well as in 43 out of 109 patients with a T1b tumor. There was a significant survival benefit for re-resected T1b patients. There was also a significant survival benefit for the 215 T2 tumors and the 75 T3 patients with IRR compared to the 441 T2 tumors and 207 T3 tumors without IRR. Comparison of liver resection techniques showed good results for the wedge resection technique in T1b and T2 carcinomas. For T3 carcinomas more radical techniques showed better results. Less than 50 % of T2–3 tumors in the registry have been re-resection.

Conclusions

The IRR should be highly recommended in patients with T1b and more advanced IGBC. The wedge resection technique is an attractive procedure for T1b and T2 IGBC due to the lower invasiveness in spite of oncological adequacy.

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Danksagung

Die Autoren danken nachfolgend aufgeführten Institutionen: CAMIC (Chirurgische Arbeitsgemeinschaft für Minimal Invasive Chirurgie), CAES (Chirurgische Arbeitsgemeinschaft für Endoskopie und Sonografie), DGCH (DeutschenGesellschaft für Chirurgie), Kliniken und Kollegen, die das Zentralregister unterstützen und unter http://www.ketteler-krankenhaus.de/register gelistet sind.

Einhaltung ethischer Richtlinien

Interessenkonflikt. T.O. Goetze und V. Paolucci geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abt. für Allgemein-, Visceral- und Minimal- Invasive Chirurgie, Ketteler- Krankenhaus, Lichtenplattenweg 85, 63071, Offenbach, Deutschland

    T.O. Goetze & V. Paolucci

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  1. T.O. Goetze
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  2. V. Paolucci
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Correspondence to T.O. Goetze.

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Goetze, T., Paolucci, V. Inzidentelle T1b- bis T3-Gallenblasenkarzinome. Chirurg 85, 131–138 (2014). https://doi.org/10.1007/s00104-013-2587-8

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