Regional lymphadenectomy improves survival in resectable gallbladder cancer: meta-analysis

Photo by National Cancer Institute / Unsplash

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Pandey Manoj, Chakraborty Shuchismita, Hansalia Dency, Dixit Ruhi, Kumar Tarun PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider regional lymphadenectomy (≥6 nodes) for resectable gallbladder cancer, but apply cautiously in T1b disease.

This meta-analysis of 27 studies evaluated the impact of regional lymphadenectomy (≥6 nodes, including retropancreatic and celiac stations) versus less extensive D1 clearance on survival in patients with resectable gallbladder cancer (T1b-T4). The primary outcome was overall survival (OS), with disease-free survival (DFS) as a secondary outcome.

The pooled analysis demonstrated a significant OS benefit for regional lymphadenectomy (HR 0.77; 95% CI 0.62-0.96). The benefit was more pronounced when at least 6 nodes were harvested (HR 0.68; 95% CI 0.57-0.81) and for D2 versus D1 dissection in T2/T3 tumors (HR 0.68; 95% CI 0.57-0.82). Thorough nodal removal also favored DFS (HR 0.63; 95% CI 0.48-0.83).

The authors acknowledge the retrospective nature of the included studies as a key limitation. No data on adverse events or follow-up duration were reported. The findings support a standardized surgical approach for resectable gallbladder cancer, but cautious application is advised for early-stage (T1b) disease due to limited evidence.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedJun 2026

PMID42105721

View Original Abstract ↓

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.