Rethinking the prognostic significance of bile spillage in gallbladder cancer

doi:10.4240/wjgs.v17.i11.113401

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Nov 27, 2025 (publication date) through Nov 25, 2025

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World Journal of Gastrointestinal Surgery

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1948-9366

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Letter to the Editor

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 21.3 Hours

Core Tip

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.