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Conventional sewage sludge disposal methods, such as incineration, are compared to advanced technologies like hydrothermal gasification (HTG) and anaerobic digestion (AD) with syngas upgrading for biomethane production. Various indicators — including environmental impacts, energy requirements, exergy efficiency, CAPEX, and OPEX — are assessed to evaluate these pathways. Results show that HTG achieves an exergy efficiency of 59.8% when coupled with a transcritical CO2 power cycle and a carbon conversion rate of 80%. Carbon management strategies, including CO2 mineralization and co-electrolysis, are also explored. Introducing a new reference environment where atmospheric CO2 is considered mineralized, the HTG route achieves 37.4% exergy efficiency with magnesium carbonate. Gasification with CO2 mineralization emerges as the preferred configuration, achieving net-negative emissions of -466 kgCO2-eq/ton of sludge. A solution space illustrates optimal trade-offs among metrics. While AD-based routes offer lower exergy efficiencies (≃16%), they balance costs and climate impact, presenting viable alternatives.