# Timing of revision surgery for incidental gallbladder cancer: a systematic review and individual patient data meta-analysis

Source: https://onco.cc/key-papers/paper-selvakumar-revision-surgery-timing-ipd-meta-analysis-hpb-2026/  
OnCo record `paper-selvakumar-revision-surgery-timing-ipd-meta-analysis-hpb-2026` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Pooling individual records from more than 2,000 patients, the timing of the second operation for chance-found gallbladder cancer made no measurable difference to survival, and studies did not even agree on what early or late meant.

## Summary

Systematic review (four databases to 10 October 2025; PROSPERO CRD42023453990) of 12 retrospective studies with 2,067 patients (566 men, 1,346 women) reporting outcomes by timing of revision surgery. There was no consensus on definitions of early, intermediate and delayed surgery. Successful revision, perioperative morbidity and R0 rates were similar across timing groups. Individual patient data meta-analysis found no difference in overall survival by timing (hazard ratio 1.29, 95 percent CI 0.79 to 2.10 for the comparison reported). Most studies scored 7 to 8 of 10 on the JBI tool.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: gallbladder-evidence
- Journal: HPB
- Year: 2026
- DOI: 10.1016/j.hpb.2025.12.017
- Authors: Selvakumar B, Patkar S, Nekarakanti PK, et al.
- Findings: 12 retrospective studies, 2,067 patients; no consensus definition of early, intermediate or delayed revision surgery.; No difference in overall survival by timing: hazard ratio 1.29 (95 percent CI 0.79 to 2.10).
- What it means: It softens the Ethun four-to-eight-week rule: timing within the range that services can deliver probably matters less than completing the operation at all and doing it with the liver bed and nodes cleared.
- Caveats: All included studies retrospective.; Timing categories differed across studies, limiting the pooled comparison.

## Sources

- HPB 2026: https://doi.org/10.1016/j.hpb.2025.12.017
- PubMed: https://pubmed.ncbi.nlm.nih.gov/41436297/

## Connected records

- key papers: [Association of Optimal Time Interval to Re-resection for Incidental Gallbladder Cancer With Overall Survival: A Multi-Institution Analysis From the US Extrahepatic Biliary Malignancy Consortium](https://onco.cc/key-papers/paper-ethun-re-resection-timing-incidental-gallbladder-cancer-jama-surg-2017/)
- cancers: [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/)
- institutions: [Tata Memorial Centre](https://onco.cc/institutions/tata-memorial/)
- terms: [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/)
- roadmaps: [Gallbladder cancer roadmap: from a chance finding at gallstone surgery to a disease with its own trials](https://onco.cc/roadmaps/gallbladder-cancer-roadmap/)
- ideas: [A national incidental gallbladder cancer pathway: histology for every gallbladder, referral within two weeks, re-resection by eight](https://onco.cc/ideas/idea-gbc-national-incidental-cancer-pathway/)

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