Incidental Gallbladder Cancer After Laparoscopic Cholecystectomy: A Comparison Between Patients With and Without
Ryutaro Watanabe1, Koji Asai1, Manabu Watanabe1
1Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan.
Introduction:
Incidental gallbladder cancer (iGBC) after laparoscopic cholecystectomy (LC) remains clinically relevant, and preoperative recognition may be especially difficult in acute cholecystitis (AC). We reviewed iGBC cases diagnosed after LC and descriptively compared cases with and without AC.
Methods:
We retrospectively reviewed 2572 consecutive LCs performed between January 2013 and November 2025. After excluding patients with preoperatively detected gallbladder polyps or suspected malignancy, 2224 patients were analyzed (AC, n = 663; non-AC, n = 1561). The denominator cohort was used to estimate iGBC incidence, and clinicopathologic details were reviewed for the 12 iGBC cases.
Results:
Twelve patients (0.54%) had iGBC. The incidence was numerically higher in the AC group than in the non-AC group (0.90% vs. 0.38%; p = 0.201), but the difference was not statistically significant. Among 11 patients with evaluable T stage, nine had T2 or deeper disease, and flat-type morphology predominated. Bile leakage occurred in two AC cases, subtotal cholecystectomy was required in one AC case and peritoneal dissemination developed in one AC case. Because only 12 iGBC cases were identified, causal interpretation was not possible.
Conclusion:
iGBC was uncommon after LC and was numerically, but not significantly, more frequent in patients with AC. These findings should be regarded as hypothesis-generating. Surgeons should maintain awareness of occult malignancy during LC for AC and should minimize uncontrolled bile contamination when bailout procedures are unavoidable.
