Firstly, what is the relationship between gallstones and gallbladder cancer?
Secondly, which is the advantage or disadvantage of gallbladder preservation surgery or gallbladder removal?
Let’s start with the causes of gallstones. Right now, the increasing incidence of gallstones in China is closely related to the change in diet structure, mainly due to the improvement in 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, which are also related to gallbladder stones.
One set of data may support this: in the Karamay region of Xinjiang, China, the incidence of gallbladder stones in the resident population over 18 years of age is 15%. This is closely related to the local dietary structure, which is dominated by beef and lamb.
There are three types of gallstones: bile pigment stones (cholesterol content <30%), cholesterol stones (cholesterol content >70%), and mixed stones (cholesterol content between the two).
Now answer the first question – what exactly is the relationship between gallstones and gallbladder cancer?
Domestic and international studies show that the proportion of gallbladder cancer combined with stones is 80-100%, and from a stone perspective, gallbladder cancer occurs in 1.5-6.3% of patients with gallbladder stones. In clinical practice, for every 100 gallbladders removed, one case of gallbladder cancer is found.
The chronic irritation of gallbladder mucosa by stones is an important pathogenic factor. Generally speaking, the larger the gallbladder stone is, 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.
Gallbladder cancer is a very scary malignant tumor, which I think is even more malignant than pancreatic cancer and liver cancer. The development process of these tumors is extremely fast, except for the accidental detection of gallbladder cancer after gallbladder removal, which is difficult to detect in early stage; when it is detected, it is basically in the middle and late stage.
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 the surrounding lymph nodes, and it is very easy for distant metastasis to occur. This also leads to a very low rate of surgical resection for intermediate and advanced gallbladder cancer.
As an aside, I had two gallbladder cancer surgeries a few days ago, and both of them were done immediately after the stomach was cut open and stitched up. Why? Because when the abdominal cavity was opened, the tumor was metastasized everywhere, so there was no way to operate.
In addition to surgery, other treatments such as chemotherapy and radiotherapy are almost ineffective for gallbladder cancer. In terms of survival rate, basically, there is no middle and late stage gallbladder cancer that can live longer than 5 years. Therefore, the incidence rate of gallbladder cancer and the death rate are basically the same, one is found and one dies, two are found and one dies.
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 death rate is extremely high.
This brings us to the second question, which is better, biliary surgery or cholecystectomy?
I don’t know if you have noticed, but tertiary hospitals basically do not do biliary surgery, but only cholecystectomy. Ever wondered why this is?
Because the gallbladder is an organ that has basically degenerated into a storehouse for bile in the human structure, and this storehouse is not very important. For example, lions and tigers catch a big prey for half a month or even a month, they 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, we are constantly eating every day, the liver is constantly secreting bile, what is the point of having the gallbladder as a warehouse?
Especially for a diseased gallbladder, it is not harmful to the body to remove it.
In my clinical career, I have diagnosed thousands of gallbladder cancer cases, among which there were even my own classmates and relatives.
They did not listen to the advice and transformed into gallbladder cancer several years later. In 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, the traditional concept of the Chinese people is that 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 after 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 reviews; if they cannot do this, I suggest that they should be opened early.