349 Operative Indication Is a Poor Predictor of Histological Inflammation in Adult Cholecystectomy: Interim Results from Feasibility of Predicting Incidental Gallbladder Cancer

Abstract Aim Patients undergoing cholecystectomy for inflammatory conditions are often prioritised for surgery over those with biliary colic. The aim of this analysis was to examine how pre-operative indications reflect underlying histological inflammation. Method Feasibility of Predicting Incidental Gallbladder Cancer (fP-iGBC) was a multicentre, trainee-led observational study conducted between October 2024 and March 2025 in eight surgical units in Southwest England. De-identified data were collected from the medical records of 508 patients undergoing cholecystectomy, and who were not known pre-operatively to have a high risk of gallbladder malignancy. For this secondary interim analysis, operative indications were compared with final histopathological diagnoses. Results Paired indication and histology data were available for 504 patients. Indications included biliary colic (262, 52.0%), cholecystitis (208, 41.3%), pancreatitis (70, 13.9%), choledocholithiasis (66, 13.1%) and gallbladder dyskinesia (1, 0.2%). Acute cholecystitis (AC) was observed in 18/262 (6.9%) patients undergoing surgery for biliary colic, 45/208 (21.6%) for cholecystitis, 4/70 (5.7%) for pancreatitis and 9/66 (13.6%) for choledocholithiasis. Chronic cholecystitis (CC) was seen in 230/262 (87.8%) undergoing surgery for biliary colic, 181/208 (87.0%) for cholecystitis, 61/70 (87.1%) for pancreatitis and 59/66 (89.4%) for choledocholithiasis. Only cholecystitis as an indication was significantly associated with histological AC (OR 4.73, p<0.001). No indication was associated with CC. Conclusions Histological inflammation was common across all operative indications, including in cases labelled as biliary colic. These findings suggest that clinical diagnoses may underestimate the true pathological burden and highlight a potential inequity in prioritisation for patients initially labelled as biliary colic, who may have under-recognised inflammatory disease.