Prophylactic (preventive) cholecystectomy
Removing a gallbladder that contains stones before it causes trouble, in the hope of preventing a cancer that almost always arises in a gallbladder with stones. Chile has run a national programme since 2006.
Overview
Because nearly all gallbladder cancers arise in gallbladders with stones and chronic inflammation, high-incidence countries have considered removing stone-bearing gallbladders preventively. In 2006 Chile's Explicit Health Guarantees (GES) programme guaranteed cholecystectomy for symptomatic gallstones at ages 35 to 49; by 2024 it had issued 284,139 notifications. Evaluations find national mortality falling before and after the programme and a faster fall in the targeted age group, but no clear break in the trend, and areas of high incidence are not always the areas of high uptake. Whether the operation should be targeted by region, ancestry or risk score rather than by age is the live question.
The most rigorous evaluation of the Chilean programme available; read alongside Mardones and Frenz (2019) and Samaniego and colleagues (2024).
The only national prophylactic cholecystectomy programme in the world has run for nearly twenty years without a design that can show whether it works. Targeting by region and risk, and building in an evaluation, is the obvious next step.
Japanese surgeons operate on gallbladder cancer far more often than UK surgeons and their guideline addresses prevention (pancreaticobiliary maljunction, polyps) as a clinical topic, which Western guidelines do not.
Together with the 2024 evaluation and the American Journal of Epidemiology analysis, this is the evidence base for whether a prophylactic cholecystectomy policy prevents gallbladder cancer deaths: suggestive in the target age band, not yet convincing nationally.
Typhoid carriage is one of the few modifiable risk factors for gallbladder cancer. In the UK it is rare, but it matters for people who grew up where typhoid is endemic and for the question of whether chronic carriers should be offered cholecystectomy.
No trial has tested cholecystectomy or surveillance for chronic carriers; the recommendation is expert inference from a fourfold risk. It is one of the prevention ideas on this page.
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