---
title: Korean national data keeps finding new diseases after gallbladder removal. When those diseases appear tells a different story
publication: Medical Insights Korea
section: news
category: Gallbladder
canonical_url: https://medicalinsightskorea.com/news/cholecystectomy-later-disease-korean-cohorts
author: James Choi
published: 2026-09-01T12:00:00+09:00
modified: 2026-09-01T12:00:00+09:00
content_type: reporting
license: Quotation permitted with attribution to Medical Insights Korea and a link to the canonical URL.
---

# Korean national data keeps finding new diseases after gallbladder removal. When those diseases appear tells a different story

Cancer, diabetes, kidney disease, depression: study after study from the National Health Insurance Service reports raised risk after cholecystectomy. In the two that separated early risk from late, the excess was concentrated in the first years and then disappeared.

## Answer

In a Korean National Health Insurance Service cohort of 715,872 patients who underwent cholecystectomy and 1,431,728 matched controls, the raised rate of hepato-biliary-pancreatic cancer diagnosis was highest one to three years after surgery and returned to a level comparable with matched controls after five to ten years.

## Key takeaways

- In a Korean cohort of 715,872 patients who underwent cholecystectomy and 1,431,728 matched controls, the incidence rate ratio for all gastrointestinal and hepato-biliary-pancreatic cancers was 1.08 (95 percent confidence interval 1.06 to 1.10), and the excess was highest one to three years after surgery before returning to the control level after five to ten years.
- In the same study the raised rates were largest for extrahepatic bile duct cancer (rate ratio 1.92) and intrahepatic bile duct cancer (1.78), and smaller for hepatocellular carcinoma (1.22) and pancreatic cancer (1.13).
- A separate cohort of 6,694 patients found depression risk raised within three years of cholecystectomy (adjusted hazard ratio 1.38, 95 percent confidence interval 1.19 to 1.59) but not beyond three years (1.09, 0.98 to 1.22), and found no association with suicide in any period.
- Other National Health Insurance Service cohorts report roughly 20 percent higher risk of type 2 diabetes (55,166 patients) and 21 percent higher risk of chronic kidney disease (116,748 patients) after cholecystectomy.
- These are observational analyses of insurance claims in which the surgical group differs from matched controls both in why they needed surgery and in how much medical attention they subsequently received, so none of them establishes that removing a gallbladder causes later disease.

## Full article

South Korea removes a great many gallbladders — the age-standardised rate more than tripled between 2003 and 2017 — and it records what happens to every one of those patients afterwards in a single national insurance database. That combination has produced a steady output of studies with a common shape: people who had a cholecystectomy went on to be diagnosed with something else more often than people who did not.

The list now runs to cancer, type 2 diabetes, chronic kidney disease, metabolic syndrome, fatty liver disease and depression. Read as a sequence of headlines it suggests that removing a gallbladder is quietly dangerous. Read with attention to when the extra diagnoses appear, it suggests something considerably less alarming.

### What the studies report

**Selected National Health Insurance Service cohort studies of outcomes after cholecystectomy**

| Outcome | Cohort | Reported effect |
| --- | --- | --- |
| GI and HBP cancer | 715,872 vs 1,431,728 | Rate ratio 1.08 (1.06–1.10) |
| All cancer | 123,295 vs 123,295 | Hazard ratio 1.19 (1.15–1.24) |
| Chronic kidney disease | 116,748 vs 116,748 | 21% higher risk |
| Type 2 diabetes | 55,166 vs 110,332 | 20% higher risk |
| Depression, within 3 years | 6,694 vs 66,940 | Hazard ratio 1.38 (1.19–1.59) |
| Depression, beyond 3 years | 6,694 vs 66,940 | Hazard ratio 1.09 (0.98–1.22) |

Each of these is a large, competently conducted matched cohort study, and each was published in a peer-reviewed journal. Taken individually, none is obviously wrong. Taken together, they raise the question of why one operation should independently cause conditions as unrelated as bile duct cancer, kidney failure and depression.

### The timing is the tell

The largest of these studies was run by Korea's National Cancer Center and published in Scientific Reports in January 2025. It compared 715,872 people who underwent cholecystectomy between 2004 and 2020 against 1,431,728 matched controls, and it did something the others largely did not: it reported when the excess cancers were diagnosed.

**1–3 years** — the window after cholecystectomy in which the raised rate of hepato-biliary-pancreatic cancer diagnosis was highest, before returning to the control level after five to ten years  
_Source: Kim YA et al., Scientific Reports, 2025_

A cause that operates through the body's physiology — bile draining continuously into the intestine instead of in pulses, say — would be expected to do its damage slowly, so that risk accumulates the longer a person lives without a gallbladder. What the data show is the opposite: a spike in the years immediately after surgery, then convergence with everyone else.

That is the signature of looking rather than of causing. A person who has an operation is scanned, has blood drawn, is followed up in a clinic and is under the eye of a hepatobiliary service. A matched control who never had gallstones is not. Cancers that were already present and would have surfaced later surface sooner, and cancers of the bile ducts — the two largest effects in the study, at rate ratios of 1.92 and 1.78 — are precisely the ones that imaging of the biliary tree would find.

> **The authors chose their word carefully**  
> The paper is titled "Increased diagnosis of hepato-biliary-pancreatic cancer after cholecystectomy", not increased incidence. Its conclusion is that these cancers are frequently diagnosed after cholecystectomy and that too short a follow-up period may hinder monitoring — a statement about surveillance, not about surgical harm.

The depression cohort shows the same pattern in a different organ system. Risk was clearly raised in the first three years after surgery and was not statistically distinguishable from the control group after that, and there was no association with suicide in any period. Recovering from an abdominal operation is a plausible reason to be low for a year. Not having a gallbladder for a decade is a less plausible one.

### The problem no adjustment fixes

There is a second reason to be cautious that applies to all of these studies at once, and it is not a defect in any of them. It is a limit of the design.

People do not receive a cholecystectomy at random. They receive one because they have gallstone disease, and gallstone disease keeps company with obesity, insulin resistance and metabolic syndrome — the same conditions that precede type 2 diabetes and chronic kidney disease. Matching on age and sex does not make two such groups alike. Adjusting for recorded comorbidities and health behaviours, as the diabetes and kidney studies did, narrows the gap without closing it, because what is adjusted for is what happens to be coded in an insurance claim.

1. Confounding by indication: the surgical group was metabolically different before anyone operated, and the reason for the operation is itself a risk factor for the outcomes being counted.
2. Detection bias: the surgical group receives imaging, laboratory tests and specialist follow-up that the control group does not, which produces more diagnoses of everything without producing more disease.
3. Shared data and shared design: these are largely the same database analysed repeatedly with the same matched-cohort approach, so agreement between them is weaker evidence than it looks.

### What this does and does not license

None of the above shows that the reported associations are spurious. Cholecystectomy does change bile physiology, and a genuine long-term effect on some of these outcomes remains possible; the diabetes and kidney findings in particular have not been explained away and their authors call for work on the mechanism.

What the evidence does not support is the reading these studies most often receive in the retelling: that having a gallbladder removed makes a person meaningfully more likely to get cancer. The largest study of that question found the excess concentrated in the years when a newly operated patient is being watched most closely, and gone by the time they are not.

> **The practical consequence**  
> For a patient deciding whether to have a symptomatic gallbladder removed, none of these findings is a reason to decline. For the health system, the National Cancer Center's actual recommendation is worth separating from the alarm: that follow-up after cholecystectomy is often too short to monitor hepato-biliary-pancreatic cancer properly. That is an argument for watching these patients longer, not for operating on them less.

## Sources

- Kim YA, Kim HJ, Kang MJ, Han SS, Park HM, Park SJ. Increased diagnosis of hepato-biliary-pancreatic cancer after cholecystectomy: a population-based study. Scientific Reports 2025;15(1):411. doi:10.1038/s41598-024-84781-7. PMID:39747399. https://doi.org/10.1038/s41598-024-84781-7
- Choi YJ, Jin EH, Lim JH, Shin CM, Kim N, Han K, Lee DH. Increased Risk of Cancer after Cholecystectomy: A Nationwide Cohort Study in Korea including 123,295 Patients. Gut and Liver 2022;16(3):465-473. doi:10.5009/gnl210009. PMID:35502586. https://doi.org/10.5009/gnl210009
- Huh JH, Lee KJ, Cho YK, Moon S, Kim YJ, Roh E, et al. Cholecystectomy Increases the Risk of Type 2 Diabetes in the Korean Population: Data From the National Health Insurance Cooperation Health Checkup 2010-2017. Annals of Surgery 2023;278(2):e264-e271. doi:10.1097/sla.0000000000005683. PMID:36066197. https://doi.org/10.1097/sla.0000000000005683
- Heo JH, Kim EJ, Jung HN, Han KD, Kang JG, Lee SJ, et al. Cholecystectomy Increases the Risk of Chronic Kidney Disease: A Nationwide Longitudinal Cohort Study. Journal of Clinical Medicine 2024;13(21):6598. doi:10.3390/jcm13216598. PMID:39518737. https://doi.org/10.3390/jcm13216598
- Yu J, Park S, Jeong S, Ko A, Lee J, Han S, Park SM. Association of cholecystectomy with short-term and long-term risks of depression and suicide. Scientific Reports 2025;15(1):6557. doi:10.1038/s41598-025-87523-5. PMID:39994212. https://doi.org/10.1038/s41598-025-87523-5
- Jeon CH, Hong J, Jung J, Moon JY, Seo HS. Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study. Annals of Surgical Treatment and Research 2022;102(4):205-213. doi:10.4174/astr.2022.102.4.205. PMID:35475231. https://doi.org/10.4174/astr.2022.102.4.205

## Citation

James Choi (2026). "Korean national data keeps finding new diseases after gallbladder removal. When those diseases appear tells a different story". Medical Insights Korea. https://medicalinsightskorea.com/news/cholecystectomy-later-disease-korean-cohorts

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