Robotic versus open surgery for gallbladder cancer: a meta-analysis of propensity-score-matched studies

Background The use of robotic surgery for gallbladder cancer (GBC) has increased in recent years. However, concerns remain regarding the safety and oncologic efficacy of robotic-assisted surgery for GBC. Objective This systematic review and meta-analysis aimed to compare the safety and efficacy of robotic radical cholecystectomy (RRC) versus open radical cholecystectomy (ORC). Methods The PubMed, Cochrane Library, Scopus, EMBASE, and Web of Science databases were searched to identify available research published up to January 13, 2026. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. Results A total of 5 propensity-score-matched studies including 629 participants (RRC group: 202 patients; ORC group: 427 patients) were included. Compared with the ORC group, the RRC group had fewer major complications (OR, 0.42), lower VAS scores (MD, −0.53), less intraoperative blood loss (MD, −114.77 mL), and shorter hospital stay (MD, −2.92 days). No significant differences were observed between the groups in mortality (OR, 1.38), overall morbidity (OR, 0.75), operative time (MD, 2.11 min), number of harvested lymph nodes (MD, 0.13), R0 resection (OR, 1.14), blood transfusion (OR, 0.25), readmission (OR, 1.22), 3-year survival rate (OR, 1.01), 5-year survival rate (OR, 1.04), 3-year disease-free survival (OR, 1.02), or 5-year disease-free survival (OR, 1.13). Conclusions This meta-analysis suggests that robotic surgery is a safe and effective approach for the surgical management of GBC, with postoperative and survival outcomes comparable to those of open surgery. Additionally, robotic surgery may be associated with shorter hospital stay, fewer major complications, reduced intraoperative blood loss, and lower VAS scores compared with open surgery. Further randomized controlled trials are warranted to confirm the potential advantages of RRC over ORC. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD420261364335.