Rethinking the prognostic significance of bile spillage in gallbladder cancer.

The largest multi-institutional cohort analysis of bile spillage in incidental gallbladder cancer was presented by van Dooren et al The study offers important insights, though certain methodological limitations and interpretative challenges temper the strength of its conclusions. We address these, clarify how statistical findings intersect with clinical relevance for bile spillage, propose a refined classification system, and provide global epidemiological context.