Surgeons can expect similar long-term outcomes when choosing between segment 4b/5 and wedge resection for gallbladder adenocarcinoma.

• 163 patients underwent randomized surgeries; segment 4b/5 took longer (318 min vs. 287 min) and had higher blood loss (265 ml vs. 223 ml).
• No differences in morbidity, mortality, or R0 resection rates were observed.
• At 27 months follow-up, mean disease-free survival was 41.8 months (4b/5) vs. 44.7 months (wedge), and mean overall survival was 45.3 months (4b/5) vs. 50.7 months (wedge).

Surgeons can select either technique without impacting oncological outcomes.