Prognose des okkulten Gallenblasenkarzinoms nach laparoskopischer und nach konventioneller Cholezystektomie (CAES/ CAMIC-Zentralregister: »Okkultes Gallenblasenkarzinom«)

Introduction: Results of earlier surveys suggest that laparoscopic cholecystectomy of incidental gallbladder cancer may increase the risk of abdominal wall metastases. These observations lead to presume that the laparoscopic procedure could deteriorate the prognosis of the gallbladder cancer. This assumptions are going to be verified by the CAES/CAMIC-registry. Method: A registry for gallbladder cancer as a incidental finding following cholecystectomy was formed by the CAE in 1997. The aim of the registry is to prospectively examine the clinical development of all patients with incidental gallbladder cancer, detected after laparoscopic as well as open cholecystectomy in order to answer the question wether laparoscopic cholecystectomy affects the course and the prognosis of patients with unsuspected gallbladder cancer. Results: Until now 194 cases of incidental gallbladder cancer following laparoscopic, 102 following open cholecystectomy as well as 45 after conversion to the open procedure have been recorded. The median follow up runs up to 31 (1-81) months. Following laparoscopic procedure 12 portesite metastases occurred, following open one 4 wound relapse occurred. An intraabdominal relapse was registered in 18 operated laparoscopically and in 7 patients operated with the open procedure. In the cases of 112 of the 341 patients a second radical procedure has been made after diagnosis of gallbladder cancer. A postoperative chemotherapy was undertaken in 20 cases, a combined radio- and chemotherapy in 14 cases. 79 patients, already died due to the underlining disease. Summary. At present, after a median follow up of 31 months, the incidence of abdominal wall metastases and the total incidence of recurrences is similar after laparoscopic and open cholecystectomy.