Should Age Limit Curative Surgery for Gallbladder Cancer?: BJS Open | August 2026

Introduction:

Gallbladder cancer (GBC) is an aggressive malignancy in which surgical resection remains the only potentially curative treatment. Older adults are often considered poor candidates for major hepatobiliary surgery because of concerns regarding postoperative complications and limited survival benefit. This large international study evaluated whether age ≥75 years independently influences surgical outcomes, recurrence, and long-term survival after curative-intent resection.

Why was this study needed?

The global population is aging, leading to more elderly patients presenting with operable gallbladder cancer.

Older adults are frequently offered less aggressive surgery and are less likely to receive adjuvant chemotherapy.

It is unclear whether poorer outcomes are due to age itself or differences in treatment.

Evidence guiding surgical decision-making in elderly patients with GBC has been limited.

Better data are needed to support individualized rather than age-based treatment decisions.

Results:

This international study analyzed 3,676 patients undergoing curative-intent surgery for gallbladder cancer across 133 centers in 41 countries.

Patients aged 75 years or older were less likely to undergo extensive surgery, lymphadenectomy, or receive adjuvant chemotherapy compared with younger patients.

Older age was associated with reduced overall survival, even after adjusting for baseline differences between age groups.

Importantly, recurrence-free survival was similar between older and younger patients, suggesting that tumor biology rather than age primarily determines recurrence risk.

Postoperative complication rates were comparable between elderly and younger patients, indicating that carefully selected older adults tolerate surgery as well as younger individuals.

Across all age groups, tumor stage and lymph node involvement remained the strongest predictors of long-term survival.

Clinical Impact:

This landmark international study challenges the practice of denying curative surgery solely on the basis of chronological age. Although older adults experienced poorer overall survival, they did not have higher postoperative complication rates or worse recurrence-free survival. The findings support a fitness-based rather than age-based approach to surgical decision-making. Careful preoperative assessment, appropriate patient selection, and consideration of adjuvant therapy remain essential to optimize outcomes in elderly patients with gallbladder cancer.

Bottom Line:

Patients aged ≥75 years undergoing curative surgery for gallbladder cancer have similar postoperative complication and recurrence rates as younger patients. Chronological age alone should not preclude curative resection; treatment decisions should be individualized based on physiological fitness, tumor stage, and expected oncological benefit.