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

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Backgrounds/Aims: 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.Methods: 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).Results: 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; I 2 = 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).Conclusions: 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.

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