Is There a Role for Prophylactic Cholecystectomy?

Gallbladder cancer is the 17th most deadly cancer worldwide, in part because it is generally diagnosed at an advanced stage, frequently for the time at surgery performed for other indications, and resection for cure is not possible. Therefore, outlining forms of early diagnosis and indications for prophylactic cholecystectomy is the best way to prevent rising death rates from this aggressive and fatal tumor. This requires an evaluation of risk factors and the identification of susceptible subgroups in whom prophylactic cholecystectomy should be beneficial. Some of the risk factors are gallstones, chronic infection by Salmonella typhi and Helicobacter, geographical distribution (rates are high in Bolivia, Colombia, India, Eastern Europe, and East Asia, with the highest rates seen in females in Chile in communities of Mapuche Indians), porcelain gallbladder, gallbladder polyps, anomalous pancreaticobiliary junction, and primary sclerosing cholangitis. Among these, there are current indications for prophylactic cholecystectomy: gallstones >3 cm, women in high-risk geographic areas, some patients with porcelain gallbladder, polyps <1 cm with risk factors or polyps >1 cm independent of the presence of risk factors, anomalous pancreaticobiliary junction, and primary sclerosing cholangitis with gallbladder mass lesions.