Zhang J, Xi B, Li J, Wen L, Deng Y, Wang CW, Zhang Y. Prophylactic cholecystectomy for asymptomatic gallstone disease: Two case reports and review of literature. World J Gastrointest Oncol 2026; 18(8): 120889 [DOI: 10.4251/wjgo.v18.i8.120889]
Corresponding Author of This Article
Yun Zhang, MD, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. bigzyun1977@zju.edu.cn
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Oncology
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case-report
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Zhang J, Xi B, Li J, Wen L, Deng Y, Wang CW, Zhang Y. Prophylactic cholecystectomy for asymptomatic gallstone disease: Two case reports and review of literature. World J Gastrointest Oncol 2026; 18(8): 120889 [DOI: 10.4251/wjgo.v18.i8.120889]
World J Gastrointest Oncol. Aug 15, 2026; 18(8): 120889 Published online Aug 15, 2026. doi: 10.4251/wjgo.v18.i8.120889
Prophylactic cholecystectomy for asymptomatic gallstone disease: Two case reports and review of literature
Bin Xi, Jin Li, Liang Wen, Yu Deng, Chao-Wei Wang, Yun Zhang, Jian Zhang
Jian Zhang, Bin Xi, Jin Li, Liang Wen, Yun Zhang, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Yu Deng, Department of Pathology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Chao-Wei Wang, Department of Stomatology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: Zhang J and Xi B analyzed and interpreted the patient data and wrote the manuscript; Zhang Y, Xi B, and Zhang J performed the surgical procedures and managed the patients perioperatively; Li J, Wen L, and Wang CW collected the data; Deng Y performed the pathological study and contributed to manuscript writing; Zhang Y conceived the study and revised this manuscript. All authors have read and approved the final manuscript.
AI contribution statement: No AI tools were used in the preparation of this manuscript.
Supported by the Natural Science Foundation of Zhejiang Province, No. LMRZ26H180001, No. LY21H100003, and No. LD19H150001.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Yun Zhang, MD, Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. bigzyun1977@zju.edu.cn
Received: March 11, 2026 Revised: April 8, 2026 Accepted: May 15, 2026 Published online: August 15, 2026 Processing time: 150 Days and 1.3 Hours
Abstract
BACKGROUND
Whether the gallbladder should be removed prophylactically for asymptomatic gallstone disease (AGD) is still debated. Gallbladder stone is a risk factor for gallbladder cancer (GBC), although the cancerization incidence associated with silent gallbladder stones is low. We herein describe two cases of AGD that resulted in xanthogranulomatous cholecystitis and GBC, aiming to investigate the debated issue and the risk factors.
CASE SUMMARY
The first case was a 62-year-old male with a history of cholecystolithiasis for > 20 years, which became symptomatic in the past 16 months. Enhanced computed tomography showed diffuse inhomogeneous thickening of the gallbladder wall, and cholecystitis with abscess was considered first. However, magnetic resonance imaging unexpectedly suggested GBC with liver involvement. After a negative biopsy pathology for tumor, surgery was still suggested. During the operation, frozen section biopsy revealed no cancer cells, and routine postoperative pathology suggested xanthogranulomatous cholecystitis. Ultimately, the patient recovered uneventfully. The second case was a 65-year-old male farmer with a history of cholecystolithiasis for > 30 years. He had experienced right upper quadrant and periumbilical pain for 2 months and yellow skin for 1 month. Imaging suggested GBC or hilar cholangiocarcinoma, with multiple intrahepatic metastases. Biopsy revealed poorly differentiated carcinoma; therefore, palliative chemotherapy was suggested.
CONCLUSION
Although prophylactic cholecystectomy is not indicated for the general population with AGD, timely operation is suggested when there are signs of abnormality or risk factors.
Core Tip: Whether the gallbladder should be removed prophylactically for asymptomatic gallstone disease (AGD) is still debated. We herein describe two cases with a long history of AGD. In the first case, magnetic resonance imaging suggested gallbladder cancer with liver involvement, but postoperative pathology demonstrated xanthogranulomatous cholecystitis. In the second case, imaging suggested metastatic gallbladder cancer, and biopsy confirmed the diagnosis. Although prophylactic cholecystectomy is not indicated for all AGDs to avoid future risk, annual follow-up is urgently needed. If signs of abnormality or risk factors are present, timely surgery is suggested.
