Defining surgical excellence in gallbladder cancer: A meta-analysis validating the 6-node threshold and extended D2 lymphadenectomy across all T-Stages.

INTRODUCTION

The surgical management of gallbladder cancer (GBC) is complicated by aggressive lymphatic spread, leading to ongoing debate regarding the optimal extent of lymphadenectomy. This study aims to evaluate the stage-specific association between nodal harvest volume, anatomical templates, and survival outcomes.

METHODS

A systematic review and meta-analysis of 27 studies (1999-2025) were conducted. Utilizing random-effects models and meta-regression, we evaluated Overall Survival (OS) and Disease-Free Survival (DFS) across pathological T-stages.

RESULTS

Regional lymphadenectomy was associated with a significant overall survival benefit (HR 0.77, 95% CI: 0.62-0.96). Subgroup analysis and meta-regression (p = 0.768) suggested this association remains consistent across the T-stage spectrum (T1b-T4). Achieving a harvest of ≥6 nodes was identified as a critical quality benchmark (HR 0.68, 95% CI: 0.57-0.81). For T2 and T3 disease, D2 dissection (including retropancreatic and celiac stations) was associated with superior outcomes compared to D1 clearance (HR 0.68, 95% CI: 0.57-0.82). Secondary analysis of DFS similarly favored thorough nodal removal (HR 0.63, 95% CI: 0.48-0.83).

CONCLUSION

Systematic lymphadenectomy of at least six nodes, incorporating the retropancreatic and celiac stations, is a critical quality metric associated with improved regional control and survival in resectable GBC. While these findings support a standardized approach, the retrospective nature of the evidence necessitates cautious application, particularly in early-stage (T1b) disease.