Although it is only a family’s opinion, but it is necessary to pass on to the gallstone patients around you to see. On the last Friday before the Mid-Autumn Festival, I had a half-day special needs clinic visit, and my heart sank like a fish in my throat, and I just wanted to cry out. Because – three patients with gallstones, all cancerous, and all have metastasis, there is no chance of surgical removal! As the chairman of the Biliary Tract Cancer Committee of the Chinese Anti-Cancer Association, I would like to talk about gallstones with you today. It is for reference only. This topic will start from the following two aspects – first, what is the relationship between gallstones and gallbladder cancer? Secondly, what are the advantages and disadvantages of biliary surgery and cholecystectomy? Let’s start with the causes of gallstones. Nowadays, the incidence of gallstones in China is getting higher and higher, which is closely related to the change of dietary structure, mainly due to the improvement of living conditions, high saturated fat and high cholesterol intake. 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, gender and other factors are also related to gallbladder stones. A set of data may support: in China’s Xinjiang Karamay region, the incidence of gallbladder stones in the resident population over 18 years of age is 15%. This is closely related to the local diet structure based on beef and mutton. Gallstones can be broadly categorized into three types: bile pigment stones (cholesterol content <30%), cholesterol stones (cholesterol content >70%), and mixed stones (cholesterol content between the two). Now to answer the first question – what exactly is the relationship between gallstones and gallbladder cancer? Studies at home and abroad have shown that the percentage of gallbladder cancer combined with stones is 80-100%, and from the stone point of view, gallbladder cancer occurs in 1.5-6.3% of patients with gallbladder stones. In clinical practice, for every 100 gallbladders removed, 1 case of gallbladder cancer is found. Chronic irritation of the gallbladder mucosa by stones is an important pathogenic factor. Generally speaking, the larger the gallbladder stones are, the higher the chances of gallbladder cancer. The risk of gallbladder cancer increases 10.1 times when the diameter of gallbladder stones is more than 3 centimeters than when the diameter of gallbladder stones is less than 1 centimeter, and the chances of gallbladder cancer when the gallbladder stones are more than 1 centimeter are 29.9 times as much as that of the people who don’t have gallbladder stones. Gallbladder cancer is a very terrible malignant tumor, and I think its malignant degree even exceeds that of pancreatic cancer and liver cancer. The development process of this kind of tumor is extremely fast, clinically it is hard to find gallbladder cancer in early stage except for the accidental discovery of gallbladder cancer after removal of gallbladder; by the time it is found, it is basically in middle or late stage. There is a saying that “the liver and gallbladder are close to each other”, which describes the inextricable relationship between the liver and gallbladder. This intimate relationship leads to the fact that gallbladder cancer near the liver gate is very easy to invade the liver and the surrounding lymph nodes, and very easy to develop distant metastasis. This also leads to a very low rate of surgical resection of middle and advanced gallbladder cancer. As an aside, I had two gallbladder cancer surgeries a few days ago, and in both cases, the stomach was cut open and immediately stitched up. Why? Because when the abdominal cavity was opened, the tumor metastasized everywhere and there was really no way to operate. Besides surgery, chemotherapy, radiotherapy and other treatments are almost ineffective for gallbladder cancer. In terms of survival rate, there is basically no gallbladder cancer in middle and late stages that lives more than 5 years. Therefore, the incidence rate of gallbladder cancer and the rate of death favor are basically the same, one dies when one is found, and two dies when two are found. In this sense, I think gallbladder cancer cannot be treated at this stage, but only prevented. How to prevent it? My point of view is that once the gallbladder lesion is found, it is better to remove it first! Because the occurrence of gallbladder cancer is precisely traceable – mainly gallbladder stones, adenoma polyps. Although the overall chance of these benign lesions becoming cancerous is very low, as mentioned earlier, once they develop into gallbladder cancer, the dead-business rate is extremely high. This brings us to the second question, which is better, bile-sparing surgery or cholecystectomy? I don’t know if you’ve noticed, but tertiary care hospitals basically don’t do biliary surgery, only cholecystectomy. Have you ever wondered why? Because the gallbladder is an organ that has basically degenerated into a warehouse for storing bile in the human body structure, and this warehouse is not very important. Let’s say, lions, tigers half a month or even a month to catch a big prey, 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 in the non-stop eating, the liver was in the non-stop secretion of bile, and also gallbladder warehouse what is the significance of it? Especially for the gallbladder with lesions, removal of the gallbladder is not harmful to the human body. In my clinical career, I have diagnosed thousands of cases of gallbladder cancer, including even my own classmates and relatives. They did not listen to advice and transformed into gallbladder cancer several years later. After an intraoperative consultation, they were diagnosed with advanced gallbladder cancer and walked away after only 3 months of life. This is all a lesson in blood at the cost of countless lives. In layman’s terms, if a benign disease of the gallbladder, such as gallbladder stones, adenomas, adenomyomatosis, etc., is not treated in time and develops into gallbladder cancer, the loss of life is just as wrong as death in a car accident! Currently, there are the following misconceptions that cause gallstone patients to obsess over whether or not to undergo surgery. First, the traditional concept of the people of China, the body hair skin, by the parents, is not easily removed. Secondly, there are rumors that gallbladder removal will easily cause colon cancer. I think this is groundless. The cause of colon cancer is similar to that of gallstones, which is mainly due to the change of dietary structure. Thirdly, textbooks say that gallbladder polyps do not need to be opened as long as they do not exceed 1 centimeter. Personally, I think this view is also incorrect. Why must we wait until there is an increasing possibility of cancer before we open this? 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 summarize, I think that if gallstones patients can adhere to regular follow-up review, then it is possible to wait until a certain stage to go to surgery to remove; if you can not do this, I suggest that it is better to open the sooner the sooner the better.