[Immediate Radical Re-Resection of Incidental T1b XXXX and the Problem of an Adequate Extent of Resection (Results of the German Registry "Incidental @entity1086 ").]

@entity1 @entity5 @entity189 @entity1086
INTRODUCTION: @entity1086 is suspected preoperatively in only 30 % of all @entity1 , while the other 70 % of cases are discovered incidentally by the pathologist (incidental or occult @entity1086 or IGBC). If @entity1086 is suspected preoperatively, an open cholecystectomy must be performed. The increasing rate of cholecystectomies via laparoscopy has lad to the detection of more @entity1086 in an early stage. Extended resection with regional lymph node dissection for T2 @entity189 and for more @entity5 has been suggested. If IGBC is detected postoperatively by the pathologist after simple cholecystectomy, radical re-resection in cases of T2 @entity5 and more advanced stages is recommended. However, it has been argued that T1b @entity5 may have spread regionally or systemically at presentation and, thus, it remains debatable whether T1b @entity5 should be treated by simple cholecystectomy or by radical resection. @entity1 / MATERIAL AND METHOD: This investigation was based on the German Registry of "Incidental @entity1086 " of the German Society of Surgery. In the present study, we evaluated whether T1 @entity189 @entity1 do profit from a radical re-resection and if the different techniques of liver resection have comparable results in T1 @entity189 . RESULTS: We analysed 684 cases of IGBC including 124 @entity1 with T1 @entity5 with a 5-year survival of 48 %. An extended re-resection increased the 5-year survival up to 68 % for T1-IGBC. The analysis shows no advantage for re-resection of T1a @entity5 . In contrast, the current analysis shows a statistically significant survival benefit for re-resection of T1b @entity5 from 34 % to 75 %. The Registry data show a trend of better survival for the @entity1 treated with the wedge resection technique compared to other resection techniques. CONCLUSION: For T1a @entity5 a simple cholecystectomy is sufficient. An immediate re-resection is highly recommended for @entity1 with IGBC in T1b stage. The wedge resection technique combined with a locoregional lymphadenectomy of the hepatoduodenal ligament seems to be the strategy of choice for T1b @entity5 . An extended re-resection is necessary to determine the nodal status exactly, and to determine an exact definite staging for @entity1 with T1b @entity5 .
