Simple Versus Radical Cholecystectomy for Pathological Stage T1B Gallbladder Cancer: A Systematic Review and...

Introduction: Gallbladder cancer (GBC) is the sixth most common gastrointestinal malignancy and the most prevalent cancer of the biliary tract. Although recent studies suggest that extended resection may be the optimal approach for managing T1b GBC, there is no clear consensus on whether simple cholecystectomy (SC) or radical cholecystectomy (RC) offers better outcomes. Therefore, we conducted this systematic review and meta-analysis to compare these two surgical techniques in the treatment of T1b GBC. Methods: We systematically searched PubMed, Embase, and the Cochrane Library through June 20, 2024. We pooled odds ratios (ORs) with 95% confidence intervals (CIs) for binary outcomes and assessed heterogeneity using the I² statistic. Results: We included 10 studies comprising 2,964 patients, of whom 51.5% underwent SC and 48.5% underwent RC. RC was associated with significantly higher 2 year (OR: 0.46; 95% CI: 0.28-0.77; P < .01; I² = 51%) and five-year overall survival rates (OR: 0.79; 95% CI: 0.64-0.98; P = .03; I² = 0%), and higher 5-year disease-specific survival (OR: 0.59; 95% CI: 0.35-0.99; P = .04; I² = 0%) compared with SC. However, we found no significant differences in 10-year overall survival (OR: 0.71; 95% CI: 0.45-1.13; P = .15; I² = 43%) or recurrence rates (OR 1.44; 95% CI: 0.72-2.88; P = .30; I² = 0%). Conclusion: RC provides a short- to medium-term survival advantage over SC in patients with T1b gallbladder cancer, but this benefit appears to diminish over time.