A new study looked at gallbladder removal during CRS/HIPEC, and the findings matter if you or someone you love is facing this surgery for appendix cancer. Taking the gallbladder out during the main operation was safe, and it often removed cancer that surgeons could not see by eye.

CRS/HIPEC is the big surgery many of us know well. Surgeons take out the tumor they can see in the belly, then wash the area with heated chemotherapy. One small part of that operation does not get talked about much. It is the gallbladder, the little organ that sits under the liver.

Doctors at the Cleveland Clinic just published a study on whether that gallbladder should come out during the same surgery. They looked back at 83 patients who had CRS/HIPEC between 2009 and 2023. Appendix cancer was the single largest group. Thirty-one of the 83 patients, about 37 percent, had appendiceal cancer. The rest had colorectal, ovarian, and other cancers that spread to the lining of the belly.

What the study found about gallbladder removal during CRS/HIPEC

Sixty-four of the patients had the gallbladder taken out during their main surgery. The safety of gallbladder removal during CRS/HIPEC was the clearest result. Out of those 64 patients, only one had a minor problem afterward. That is a very low complication rate for an operation this large.

The surprising part was what the gallbladders held. Twenty-eight of the 64 that were removed, close to half, had cancer in them when the lab looked. And the surgeons could not reliably tell which ones. When a surgeon judged a gallbladder by how it looked during the operation, that guess matched the lab result only about 56 percent of the time. A gallbladder that looked clean could still have cancer hiding inside.

The other side of the study is what happened to the 19 patients who kept their gallbladder. Eleven of them, well over half, needed a gallbladder procedure later on. Nine required a second, separate operation to remove it. Every one of those later removals had to be done the open way, with a full incision, rather than the smaller keyhole approach. That is a harder surgery and a longer recovery, especially in a belly that has already been through CRS/HIPEC. Two of these patients died from serious infections tied to the gallbladder.

What this means, and what it does not

So the case for gallbladder removal during CRS/HIPEC rests on two ideas. It appears to be safe when done during the main operation. And it may catch hidden cancer and prevent a second surgery down the road.

I want to be honest about the limits, because this is one study and not the final word. It came from a single hospital, and the researchers looked back at old records instead of following patients forward. The patients who had their gallbladder removed also happened to have less cancer spread to begin with, so the two groups were not a perfect match. And the gallbladder findings were pooled across every cancer type in the study. The researchers did not break the numbers out for appendix cancer on its own. This study also does not tell us anything specific about how the different appendiceal subtypes behave, such as goblet cell, signet ring cell, or low-grade mucinous tumors. It is a signal, not proof.

What it does give you is a fair question to bring to your surgical oncologist before CRS/HIPEC. You can ask whether they plan to remove the gallbladder during your surgery, and why or why not. There is no formal guideline that settles this yet, so surgeons make the call based on their own judgment. Asking the question puts it on the table.

Common questions

Is gallbladder removal during CRS/HIPEC safe?

In this Cleveland Clinic study of 64 patients, it was. Only one person had a minor complication. Removing the gallbladder during the main surgery did not add meaningful risk.

Why would a surgeon remove a gallbladder that looks fine?

Because it may not be fine. Nearly half of the removed gallbladders in the study had cancer inside, and the way a gallbladder looks during surgery matched the lab result only about half the time.

What happens if the gallbladder is left in?

Some people are fine. But in this study, more than half of the patients who kept their gallbladder later needed a procedure for it, and those follow-up surgeries were harder and riskier.

Does this apply to my specific type of appendix cancer?

The study did not break its results out by subtype, so it cannot answer that directly. It is a reason to ask your own surgical oncologist, not a rule for every case.

Source: Hernandez Dominguez O, Moussally M, Gorgun E, et al. Evaluating the Practice of Cholecystectomy During Cytoreductive Surgery with HIPEC. Journal of Gastrointestinal Surgery Open. 2026. Open access: doi.org/10.1016/j.jogsop.2026.100032

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