Kurzfassung der aktualisierten S3-Leitlinie der DGVS und DGVC zur Diagnostik und Behandlung von Gallensteinen

Abstract

This short version of the guidelines summarizes the evidence-based key recommendations for the diagnosis and treatment of gallstones. The guidelines were developed by an interdisciplinary team of gastroenterologists, surgeons, radiologists, geneticists, and patient support groups, under the auspice of the German Society for Gastroenterology and Metabolic Diseases and the German Society for General Surgery and Surgery of the Alimentary Tract. It used structural level 3 consensus-based methodology and includes statements on clinical practice, prevention, quality assurance, outcome analysis, and integration of outpatient and inpatient care for patients with gallstone disease.

Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry

“…In this study, all patients who had a radical re-resection were treated according to the S3 Guidelines in Germany [30]. Patients had a liver resection either as a wedge resection of the gallbladder bed with a 3-cm margin in the liver or as an anatomic resection of liver segments IVb/V combined with a locoregional lymph node dissection of the hepatoduodenal ligament.…”

“…In addition, locoregional lymph node dissection of the hepatoduodenal ligament should be performed. It remains unclear whether a wedge resection with a margin of 2 cm [6] to 3 cm [30] has the same prognosis as an anatomic resection of segments IVb/V. Micrometastases [31] and direct extension of the tumor through the gallbladder wall into the liver [29,32] are reasons for these two kinds of liver resection techniques.…”

“…In the present study, we evaluated the efficacy of the wedge-resection technique and the bisegmentectomy of IVb/V combined with standardized lymph node dissection of the hepatoduodenal ligament based on the criteria of the S3 Guidelines [30] and other hepatic resection techniques combined with, for example, extrahepatic bile duct resection or en bloc resection with adjacent organs to make the procedure more radical. We analyzed 624 cases of IGBC with the aim of clarifying whether different techniques of liver resection have comparable results or if they differ depending on the tumor stage.…”

“…According to the effective guidelines in Germany [30], radical cholecystectomy includes a liver resection as a wedge resection of the gallbladder bed with a margin of 3 cm in the liver or an anatomic resection of liver segments IVb/V. In addition, locoregional lymph node dissection of the hepatoduodenal ligament should be performed.…”

“…Extended resection with regional lymph node dissection for T2 carcinomas and for more advanced carcinomas has been suggested [11,[26][27][28][29]. If IGBC is detected postoperatively by the pathologist after simple cholecystectomy, radical re-resection in cases of T2 tumors and more advanced stages is recommended [30].…”