Carcinoma of the gallbladder. Its relation to cholelithiasis and to the concept of prophylactic cholecystectomy.

Two hundred and thirteen cases of carcinoma of the gallbladder are reviewed with special reference to the presence or absence of symptoms of cholelithiasis. The majority of the patients (58%) had no history of cholelithiasis. Only one patient out of ten (11%) had gallstones known to have existed for more than a year, and the rest of the patients had a short history. A marked decrease in the cholecystectomy rate did not seem to affect the incidence of carcinoma over a period of eight years (1969--1976). Therefore cholecystectomy as prophylaxis against carcinoma does not seem to be justified. The only way to improve the prognosis of carcinoma of the gallbladder is to reduce the time between the onset of symptoms and surgery. The relative risk of carcinoma is ten times greater than symptoms and signs of cholecystitis are recorded and increases markedly beyond the age of sixty. Early surgery in these groups is recommended.