Researchers from Korea discovered that the risk of developing cholangiocarcinoma (CCA) was significantly increased in patients that have complicated gallstones but partially reduced in patients who underwent cholecystectomies, as published in the Journal of Gastroenterology and Hepatology.

“A positive association between gallstones and [CCA] or hepatocellular carcinoma (HCC) has been reported with a 2.0- 2.5 fold risk compared to the general population,” the researchers wrote.

Cholecystectomy is a common elective abdominal surgery performed, but whether it reduces the risk of patients developing CCA and HCC remains controversial. The researchers hence decided to investigate the effect of cholecystectomies on the risk of patients with gallstones developing CCA or HCC.

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Using the Korean National Health Insurance database, they were able to identify 958,677 patients with gallstone diseases, as well as sex-matched controls (n=9,586,770). Complicated gallstones were defined as acute cholecystitis, acute cholangitis, as well as severely complicated gallbladders including fistulas, perforations, and hydrops. 

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The patients were grouped according to whether they underwent cholecystectomies. The researchers then identified patients that developed CCA or HCC. The results demonstrated that patients with gallstones had statistically significant increased risks of developing CCA and HCC compared to the control group.

The researchers also discovered that while cholecystectomies had minimal effects on the risks of developing CCA and HCC, patients with complicated gallstones had highly increased risks of developing CCA, with cholecystectomies reducing those risks by 30%. The risk of developing HCC was not statistically significant in patients who underwent cholecystectomies compared to those who did not. 

“In conclusion, this study demonstrated the effects of gallstones and subsequent cholecystectomy on the risk of hepatobiliary cancers,” the authors wrote.

“Therefore, we strongly recommend cholecystectomy for complicated gallstones and surveillance for CCA in patients who could not undergo cholecystectomy despite having gallstone-related complications (especially acute cholangitis) and additional risk factors such as chronic liver diseases and diabetes mellitus.”


Ahn HS, Kim HJ, Kang TU, Park SM. Cholecystectomy reduces the risk of cholangiocarcinoma in patients with complicated gallstones, but has negligible effect on hepatocellular carcinomaJ Gastroenterol Hepatol. Published online December 14, 2021. doi:10.1111/jgh.15759