gms | German Medical Science

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 already in T1b-tumors. The questions is whether the performance of Liver resection (LR) for IGBC`s depends more on the experience of the hospitals in liver surgery than in respecting the Guidelines in Germany.

Methods: For data analysis, we used the German registry (GR). In 2010 we started a second form by asking for the frequency of liver resections in the various hospitals (Liver resection study-LSR). The indication for LR was irrelevant. The aim was to get the overall frequency in liver resections of the clinics. We divided hospitals into high- (HV) , mid- (MV) low-volume (LV) LR hospitals.

Results: To date more than 900 cases of IGBC have been analyzed. There is a significant survival benefit for IGBC with IRR in T1b- , T2 and T3-carcinomas. Comparison of liver resection techniques shows good results for the wedge- resection technique in T1b- and T2- carcinomas. For T3- carcinomas more radical techniques show better results. The LRS includes 487 IGBC`s from 167 centers. There were 36 HV`s, 32 MV`s, and 99 LV`s. LV`s perform LR for T2-3 gallbladder carcinomas significantly less often. In HV`s and MV`s, 61% of patients with an indication for liver resection received LR, but in LV centers, only 41% with an indication for LR received a LR (p < 0.001). In cases of T1b carcinomas, LR was performed significantly more often in HV`s (p = 0.009).

Conclusion: Less than 50% of patients in the GR with an indication for LR (T2-3) have received a LR, as recommended by the German Guidelines. Thus it appears that recommendations of Guidelines are often not being followed. A good portion of IGBC`s are treated in LV centers, but LV centers are indicating LR significantly less often than HV or MV in patients with T2-3 carcinomas, a tumor stage where liver resection is recommended. The central problem is that the performance of a liver resection in IGBC patients in Germany seems to depend much more on the hospital’s volume of liver surgery than on respecting the Guidelines. IRR should be highly recommended in patients with T1b and more advanced IGBC`s. Wedge- resection technique is an attractive procedures for T1b- and T2- IGBC`s.