Liau MYQ, Shelat VG. Rethinking the prognostic significance of bile spillage in gallbladder cancer. World J Gastrointest Surg 2025; 17(11): 113401 [DOI: 10.4240/wjgs.v17.i11.113401]
Corresponding Author of This Article
Vishal G Shelat, Associate Professor, Consultant, FRCS (Gen Surg), Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@rediffmail.com
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Surgery
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Letter to the Editor
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 27, 2025 (publication date) through Nov 25, 2025
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Publication Name
World Journal of Gastrointestinal Surgery
ISSN
1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Liau MYQ, Shelat VG. Rethinking the prognostic significance of bile spillage in gallbladder cancer. World J Gastrointest Surg 2025; 17(11): 113401 [DOI: 10.4240/wjgs.v17.i11.113401]
World J Gastrointest Surg. Nov 27, 2025; 17(11): 113401 Published online Nov 27, 2025. doi: 10.4240/wjgs.v17.i11.113401
Rethinking the prognostic significance of bile spillage in gallbladder cancer
Matthias Yi Quan Liau, Vishal G Shelat
Matthias Yi Quan Liau, Department of General Surgery, Woodlands Health, Singapore 737628, Singapore
Vishal G Shelat, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
Author contributions: Liau MYQ and Shelat VG participated in drafting the manuscript. All authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vishal G Shelat, Associate Professor, Consultant, FRCS (Gen Surg), Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore. vgshelat@rediffmail.com
Received: August 25, 2025 Revised: September 14, 2025 Accepted: October 10, 2025 Published online: November 27, 2025 Processing time: 92 Days and 21.4 Hours
Abstract
The largest multi-institutional cohort analysis of bile spillage in incidental gallbladder cancer was presented by van Dooren et al The study offers important insights, though certain methodological limitations and interpretative challenges temper the strength of its conclusions. We address these, clarify how statistical findings intersect with clinical relevance for bile spillage, propose a refined classification system, and provide global epidemiological context.
Core Tip: Bile spillage remains clinically relevant in incidental gallbladder cancer despite loss of statistical independence in multivariate overall survival analysis. This letter contextualizes gallbladder cancer incidence globally, identifies methodological flaws and a key limitation in van Dooren et al, and proposes a bile spillage classification framework.
