Identifying residual disease in incidental gallbladder cancer is crucial for improving surgical outcomes.

• Residual disease was found in 36% of patients, significantly lowering recurrence-free survival (42 months vs. 11 months) and overall survival (60 months vs. 22 months).
• Key risk factors for residual disease include CA19-9 levels >39 U/ml, open cholecystectomy, and advanced tumor stages.
• Segment IVB/V resection and adjuvant chemotherapy drastically enhance survival rates for patients with residual disease.

Surgeons should consider these factors when planning treatment to optimize patient management and outcomes.