Rethinking the prognostic significance of bile spillage in gallbladder cancer

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.

Keywords: Gallbladder cancer; Bile spillage; Prognosis; Survival; Cholecystectomy

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.