Is gallbladder cancer decreasing in view of increasing laparoscopic cholecystectomy?

Background: Gallstone disease affects over 20 million people in the U.S. and is a major risk factor for gallbladder cancer (GBC). In 1988, a less invasive, low-cost procedure, laparoscopic cholecystectomy (LC), was introduced and became the standard of care for management of gallstones.

Methods: GBC incidence (1973-2007) and mortality rates (1969-2006) were calculated using SEER Program data. LC rates (1993-2008) were obtained from NAMCS, NHAMCS, and HCUP. Annual percent change was estimated by gender, age, and race, and the statistical significance was assessed at p < 0.05. Correlation analysis was performed on GBC and LC trends.

Results: Since the early 1970s, GBC incidence and mortality rate have declined. Women and older age groups continue to have the highest risk for GBC, despite having greater declines. Incidence significantly decreased among whites, but did not among blacks. The number of inpatient LC procedures increased by 15% between 1994 and 2008; however, inpatient and outpatient LC rates remained stable. LC rate was not significantly correlated with either GBC incidence or mortality.

Conclusions: The decline in incidence and mortality of GBC began decades before the introduction of LC and apparently has stabilized in the past decade. No temporal relationship existed between LC rate and the incidence and mortality rates of GBC. Our study suggests that prevention of a rare tumor may be extremely difficult if the surgical removal of a risk factor is involved.