Xanthogranulomatous Cholecystitis in a GBC Endemic Zone: Diagnostic Uncertainty Drives Unnecessary Extended Resection and Major Surgical Morbidity

Abstract

Background: Xanthogranulomatous Cholecystitis (XGC) is a benign inflammatory condition whose features often closely mimic Gallbladder Carcinoma (GBC). In GBC-endemic regions like Eastern India, this diagnostic uncertainty is intensified, frequently leading to unnecessary radical surgical intervention. This study aimed to characterize the clinical presentation, diagnostic limitations, and surgical burden of XGC in a high-risk cohort. Methods: This was a retrospective, single-center study of 48 patients with histopathologically confirmed pure XGC over a two-year period (Jan 2022–Dec 2023). Postoperative outcomes were rigorously assessed using the Clavien-Dindo classification. Results: The cohort showed a marked female predominance (62.5%) and mean age (53.8 years) consistent with local GBC demographics. Radiological non-specificity was profound: 91.7% of benign XGC cases exhibited mucosal gap/disruption, a feature conventionally associated with malignancy. This severe diagnostic uncertainty resulted in 37.5% of patients undergoing unnecessary extended resections, which translated to a high 20.8% major postoperative complication rate (Clavien-Dindo ≥IIIa). Conclusion: The high clinical and surgical burden of XGC demands an urgent institutional shift toward a definitive preoperative diagnosis, necessitating immediate review of imaging and frozen section standards. The essential next step is a prospective, multi-center study to develop and validate a Machine Learning (ML)-based predictive nomogram to ensure the diagnostic certainty required for safe, conservative XGC management.