During the two weeks of Spring Festival, two patients with gallbladder cancer were admitted to the inpatient department, and both of them had metastasis and had no chance of surgical resection. Today, I would like to talk to you about the relationship between gallstones, gallbladder stones and gallbladder cancer, and the pros and cons of gallbladder surgery and gallbladder removal. The relationship between gallbladder stones and gallbladder cancer First of all, let’s start with the causes of gallstones. Nowadays, the increasing incidence of gallstones in China is closely related to the change of diet structure, mainly the improvement of living conditions and the high intake of high saturated fat and high cholesterol. Of course there are also factors such as living environment, body mass index, history of fatty liver disease, history of diabetes, family history of gallbladder disease, and gender that are associated with gallbladder stones. Of course not all gallbladder stones will eventually lead to gallbladder cancer, but some data show that more than 90% of gallbladder cancer patients are accompanied by gallbladder stones. Long-term gallbladder stones often cause gallbladder atrophy and calcification, and the incidence of gallbladder cancer is higher in patients with calcified gallbladder or porcelain-like gallbladder. The chronic irritation of gallbladder mucosa by stones is an important pathogenic factor. Generally speaking, the larger the gallbladder stones are, the higher the chance of gallbladder cancer. The risk of gallbladder cancer is 10.1 times higher for gallbladder stones larger than 3 cm in diameter than for those below 1 cm in diameter, and the chance of gallbladder cancer is 29.9 times higher for those with gallbladder stones larger than 1 cm than for those without gallbladder stones. In recent years, the incidence rate of gallbladder stones and gallbladder cancer in China has been rising continuously, and the current incidence rate of gallbladder stones in China is 3% to 10%, and there are thousands of new gallbladder cancer patients every year, which are 1 to 2 times higher than those 10 years ago. There is a saying that “the liver and gallbladder are inseparable”, which describes the inextricable relationship between the liver and gallbladder. This intimate relationship causes gallbladder cancer near the liver gate to easily invade the liver and surrounding lymph nodes, and is very prone to distant metastasis. This also leads to a very low rate of surgical resection for intermediate and advanced gallbladder cancer. As a side note, in the two gallbladder cancer surgeries I did in front of me, both of them were stitched up immediately after the stomach was cut open. Why? Because when the abdominal cavity was opened, the tumor was metastasized everywhere, so there was no way to operate. You should know that other treatments such as chemotherapy and radiotherapy are almost ineffective for gallbladder cancer except for surgery! In terms of survival rate, basically, there is no mid- to late-stage gallbladder cancer that can live longer than 5 years. Therefore, in this sense, I think gallbladder cancer cannot be treated at this stage, but can only be prevented. Then how to prevent it? My opinion is that once gallbladder lesion is found, it is better to remove it first! Because the occurrence of gallbladder cancer is precisely traceable – mainly gallbladder stones and adenomatous polyps. Although the overall chance of these benign lesions becoming cancerous is very low, as mentioned above, once they develop into gallbladder cancer, the mortality rate is extremely high. This brings us to the second question, which is better, biliary surgery or cholecystectomy? I don’t know if you’ve noticed, but there are very few tertiary care hospitals that perform biliary surgery, and even the screening process before biliary surgery is very strict, so that very few patients can actually undergo biliary surgery. Ever wonder why this is? Because the gallbladder, an organ in the human structure, has basically degenerated into a warehouse for storing bile, and this warehouse is not very important. For example, lions and tigers catch a large prey for half a month or even a month, need a lot of bile to digest, usually these bile are stored in the gallbladder, for them, the gallbladder is still very important; but for us modern people, every day are constantly eating, the liver is constantly secreting bile, but also the gallbladder this warehouse what is the significance of it? Especially for a diseased gallbladder, it is not harmful to remove it, but if a diseased gallbladder is forcibly retained, it is like leaving a lesion in the body, the consequences are unthinkable. In my clinical career, I have encountered numerous gallstone patients with indications for surgery who were unwilling to remove their gallbladders, and they did not listen to the advice and transformed into gallbladder cancer several years later. At the intraoperative consultation, they were diagnosed with advanced gallbladder cancer and walked away after living for only 3 months. This is all a blood lesson learned at the cost of countless lives. In common parlance, if a benign disease of the gallbladder, such as gallbladder stones, adenoma, adenomyomatosis, etc., is not treated in time and develops into gallbladder cancer, the loss of life is as wrongful as death in a car accident! At present, there are the following misconceptions that cause gallstones patients to struggle with whether to have surgery or not. Firstly, according to the traditional concept of the Chinese people, the body’s hair and skin should not be removed easily. Secondly, there are rumors that gallbladder removal can easily cause colon cancer. I think this is unfounded. The cause of colon cancer is similar to gallstones, and it is mainly due to the change of diet structure. Thirdly, textbooks say that gallbladder polyps do not need to be opened as long as they do not exceed 1 cm. I personally think this view is also incorrect. Why must we wait until the possibility of cancer becomes more and more likely before opening this surgery? Moreover, some studies have shown that polyp size is not a safe exclusion indicator for tumors, and polyps less than 10 mm in diameter may still be malignant! To sum up, I think gallstones patients can wait until a certain stage before surgical removal if they can insist on regular follow-up review; if they cannot do this, I suggest it is better to open early and get rid of the problem. If the condition allows, you must review regularly, follow up in time, and remove as soon as there is a hint. In order to prevent “harm to the life of the Secretary”.