Extended versus simple cholecystectomy for pathologic T1b gallbladder cancer: A systematic review and meta-analysis

The optimal surgical approach for pathologic T1b gallbladder cancer (GBC) is debated, with conflicting data on whether extended cholecystectomy (EC) offers a survival advantage over simple cholecystectomy (SC). To address this, we performed a systematic review and meta-analysis comparing oncologic outcomes between EC and SC specifically in patients with pathologically confirmed T1b GBC.

We searched MEDLINE, Embase, and the Cochrane database from their inception to July 2025. We included studies that compared EC to SC in pT1b GBC and reported overall survival (OS), disease-specific survival (DSS), or recurrence rate. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pool7ed using fixed- or random-effects models, depending on heterogeneity. The ROBINS-I tool was used to assess the risk of bias. This study is registered with PROSPERO (CRD42024498316).

Our analysis included 26 non-randomized comparative cohorts, comprising 1,316 patients. No study was deemed to have a low risk of bias (11 were moderate, 16 serious). EC was linked to significantly better 5-year OS compared to SC (HR 0.48; 95% CI 0.33-0.70; p = 0.0001; I² = 53%), with consistent results across institutional and registry-based subgroups, as well as geographic regions. However, no statistically significant differences were found in 5-year DSS (HR 0.73; 95% CI 0.41-1.28; p = 0.27) or recurrence-free survival (RFS) (RR 0.75; 95% CI 0.57-1.00; p = 0.0504).

While EC was associated with improved OS in pT1b GBC, it did not demonstrate a benefit for DSS or recurrence rate. Given the inherent limitations of the retrospective evidence, these findings advocate for a risk-adapted surgical strategy and highlight the critical need for prospective studies with standardized operative and pathologic definitions.