title: Prognosis of incidental gallbladder carcinoma is not influenced by the primary access technique: analysis of 837 incidental gallbladder carcinomas in the German Registry.
abstract: BACKGROUND
  The use of the laparoscopic approach (LC) for gallbladder carcinoma and incidental gallbladder carcinomas (IGBC) remains controversial. However, recent studies suggest that LC has no adverse effects relative to the open approach. A definitive conclusion regarding the safety of LC that is based on data from a large patient cohort is needed.
  
  
  METHODS
  To draw a definite conclusion about the safety of LC in IGBC, data from the 837 patients with IGBC [registered in the German Registry (GR)] were analyzed.
  
  
  RESULTS
  Of the 837 patients, 492 underwent LC, 200 underwent open surgery (OC), and 142 initially underwent LC, but the approach was converted to OC. The 5-year survival rates of the three groups indicated that LC was associated with significantly better survival. LC was not associated with a poorer prognosis in patients with T1, T2, or T3 stage disease or in patients who underwent immediate radical re-resection (IRR; n = 330). LC was associated with a significant survival benefit in the 490 patients who did not undergo IRR. LC was comparable with OC in terms of overall recurrence rates and the rate of accidental intraoperative perforation.
  
  
  CONCLUSIONS
  The GR data, which relate to a large homogenous patient cohort, showed that when other potential influencing factors, e.g., IRR were eliminated, the primary access technique had no effect on prognosis. Stage-adjusted therapy should always be performed irrespective of the primary access technique.
authors: Department of Surgery, Ketteler-Krankenhaus, 63071 Offenbach, Germany. ThGoetze@aol.com
authors: Thorsten Oliver
authors: TO
authors: Goetze
authors: Vittorio
authors: V
authors: Paolucci
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D033162:Incidental Findings; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D012042:Registries; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
references: Arch Surg. 2010 Feb;145(2):128-33
references: 20157079
references: J Am Coll Surg. 2001 Feb;192(2):189-95
references: 11220719
references: Surgery. 1993 Mar;113(3):355-8
references: 7772085
references: Lancet Oncol. 2003 Mar;4(3):167-76
references: 12623362
references: Surg Endosc. 2010 Sep;24(9):2156-64
references: 20177938
references: Eur J Surg Oncol. 2009 Sep;35(9):903-7
references: 19261430
references: J Gastrointest Surg. 2007 Nov;11(11):1478-86; discussion 1486-7
references: 17846848
references: Surgery. 1998 Nov;124(5):831-8
references: 9823395
references: Oncol Rep. 1999 Mar-Apr;6(2):283-7
references: 10022990
references: Eur J Surg Oncol. 2008 Mar;34(3):306-12
references: 17964753
references: J Gastrointestin Liver Dis. 2006 Dec;15(4):333-5
references: 17205143
references: Ann Surg. 2008 Jan;247(1):104-8
references: 18156929
references: J Hepatobiliary Pancreat Surg. 2002;9(2):256-60
references: 12140616
references: Surg Endosc. 2012 May;26(5):1382-9
references: 22089259
references: World J Surg. 2004 Feb;28(2):160-5
references: 14708053
references: Surg Endosc. 2008 Nov;22(11):2462-5
references: 18247090
references: Ann Surg. 2000 Oct;232(4):557-69
references: 10998654
references: Hepatogastroenterology. 1998 Jan-Feb;45(19):81-2
references: 9496492
references: Clin Transl Oncol. 2011 Jan;13(1):25-33
references: 21239352
references: Semin Surg Oncol. 1999 Jun;16(4):327-31
references: 10332779
references: Ann Surg Oncol. 2009 Aug;16(8):2101-15
references: 19495882
references: Eur J Surg Oncol. 2002 Feb;28(1):4-10
references: 11869005
references: World J Surg. 2003 Mar;27(3):266-71
references: 12607049
references: Eur J Surg Oncol. 2001 Apr;27(3):225-8
references: 11373097
references: Int Surg. 1999 Oct-Dec;84(4):344-9
references: 10667815
references: Surg Endosc. 2007 Sep;21(9):1582-7
references: 17479340
references: J Surg Oncol. 2005 Sep 15;91(4):253-7
references: 16121343
references: J Am Coll Surg. 2000 Aug;191(2):158-63
references: 10945359
references: J Nippon Med Sch. 2006 Jun;73(3):136-40
references: 16790980
references: J Laparoendosc Surg. 1996 Feb;6(1):35-45
references: 8919176
references: Surg Endosc. 2002 May;16(5):828-32
references: 11997831
references: Surg Endosc. 2006 Feb;20(2):286-93
references: 16362480
references: J Laparoendosc Adv Surg Tech A. 1999 Jun;9(3):283-4
references: 10414547
references: Z Gastroenterol. 2007 Sep;45(9):971-1001
references: 17874360
references: Surg Endosc. 1995 Mar;9(3):348-50
references: 7597613
references: World J Surg. 2004 Jun;28(6):544-7
references: 15366742
references: Ann Surg. 2007 Jun;245(6):893-901
references: 17522515
references: N Engl J Med. 1991 Oct 31;325(18):1316
references: 1833645
references: Surg Endosc. 2000 Aug;14(8):712-6
references: 10954815
references: Surg Endosc. 2006 Dec;20(12):1867-71
references: 17031747