Beyond station 16: A pathway-aware framework for gallbladder cancer lymphadenectomy after neoadjuvant therapy

Table 1 Pathway-oriented interpretation of gallbladder cancer lymphadenectomy

Pathway	Main stations	Meaning	Proposed surgical consideration	Key caution
Cholecysto-celiac	12 → 8 → 9 → 16	Spread through the hepatoduodenal ligament toward the common hepatic artery and celiac axis	Consider stations 8 and 9 when stage, imaging or intraoperative findings suggest celiac-route risk	Schematic pathway based on anatomical literature; not a universal sequence
Cholecysto-retropancreatic	12 → 13 → 17 → 16	Main route described in anatomical studies; involves posterior pancreatic head and inferior pancreatic border	Consider retropancreatic exposure and station 13/17 assessment when suspicious or high-risk	Station 13/17 relevance does not automatically imply pancreaticoduodenectomy
Cholecysto-mesenteric	12 → 14 → 16	Drainage toward the superior mesenteric root and vessels	Consider station 14 around both SMA and SMV when mesenteric-route risk is present	Apparent skip disease may reflect a recognized route but remains variably reported
Para-aortic/interaortocaval convergence	16a2/16b1	Terminal convergence near the left renal vein and interaortocaval space	Sampling may avoid futile surgery; clearance is investigational in selected responders	Do not infer therapeutic benefit from anatomy alone

The station sequences are schematic and based on classical anatomical studies and Japanese Society of Biliary Surgery nomenclature[4-6]. They do not exclude anatomical variability or alternative drainage. Surgical implications are proposed considerations, not uniform requirements. SMA: Superior mesenteric artery; SMV: Superior mesenteric vein.