119 Management of Porcelain Gallbladder: A Systematic Review of Treatment Approaches

Abstract Aim To evaluate treatment strategies and outcomes in patients with porcelain gallbladder associated with gallbladder carcinoma and assess the efficacy of surgical versus conservative management approaches through a systematic review of published case reports and retrospective studies. Method A systematic search of PubMed, Cochrane Library, and Google Scholar was performed for English-language case reports and retrospective studies published in the last 20 years. Studies reporting treatment and outcomes of patients with porcelain gallbladder and gallbladder carcinoma were included. Data on demographics, treatment modalities, survival, recurrence, and complications were extracted and analysed narratively due to study heterogeneity. Risk of bias was assessed using the JBI Critical Appraisal Tool. Results Ten studies involving 211 patients were included. Porcelain gallbladder often presented incidentally or with nonspecific symptoms, and diagnosis of malignancy was frequently confirmed post-cholecystectomy. Histological subtypes of porcelain gallbladder influenced malignancy risk: selective mucosal calcification was associated with up to 7% cancer risk, while complete intramural calcification had negligible risk. Surgical resection, particularly cholecystectomy with liver segmentectomy and lymphadenectomy, offered improved survival in early-stage disease. However, most patients presented at advanced stages requiring palliative or conservative management, including chemotherapy or supportive care. Survival outcomes varied significantly by age, disease stage, and comorbidities. Conclusions Porcelain gallbladder remains a complex clinical entity with variable malignant potential. While surgery is beneficial in early-stage disease, conservative approaches predominate in advanced cases. Individualised treatment based on patient factors and tumour staging is essential. Further prospective research is needed to refine management guidelines and risk stratification in porcelain gallbladder.