Curative treatment in gallbladder cancer: Adjuvant or multimodal concepts—Evidence from data of 975 cases of The German Registry of Incidental Gallbladder Carcinoma.

Abstract

367 Background: Incidental gallbladder cancer (IGBC) in T1b-3 stage do profit from radical cholecystectomy but nevertheless the cure rate in T2-3 carcinomas is disappointing. For improvement, following questions are of interest. What is significant regarding adjuvant or multimodal aspects? Which technique of liver resection (LR) and lymph- node dissection (LAD) is meaningful? Role of lymph node ratio (LNR)? Answers based on the data of 975 IGBC of the GR- platform. Methods: For data analysis we used the German- Registry- platform (GR). The GR is a network of more than 300 clinics in Germany. More than 1000 cases of IGBC are registered and to the knowledge of the authors the largest prospective gallbladder registry worldwide. Results: To date more than 1000 IGBC in the GR have been registered, n = 975 analyzed. In 44 of 119 T1b cases there was an IRR, with a significant survival benefit for T1b after IRR. There was also a significant survival benefit for the 244 T2 and 86 T3 with IRR of the 492 T2 and 228 T3 tumors. Comparison of LR showed good results for the wedge resection technique (WRT) in T1b and T2. For T3 more radical techniques showed better results. In 233 patients the LNR could be calculated. Statistic indicates that LNR has a significant influence on prognosis. The results show that the referral of patients from a LV to a HV has no practical relevance. In n = 433 T2 / T3 patients there are data calculated about adjuvant therapy, with a highly significant survival benefit after adjuvant therapy in T2 and a trend for a survival benefit in T3 carcinomas. Positive effect of adjuvant therapy exists in the subgroup with and without re- resection but was more evident in patients without radical resection. Conclusions: IGBC's up to T1b needs radical surgery. The WRT is attractive for T1b / T2 IGBC. LAD and LNR are of prognostic relevance. In 433 T2-3 IGBC's, adjuvant therapy has a positive effect, especially in cases without radical surgery. Regimen will be discussed at the meeting. For further improvement in T2-3 IGBC a multimodal therapy (GAIN-) trial has already been planned by the investigator of the GR under the support of the GR- platform with more than 300 clinics in Germany.