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

Table 4 Practical station-specific decision criteria in selected patients

Station/region	Primary purpose	When to consider	When to avoid
12	Regional staging and gateway assessment	Radical/re-resection intended to stage beyond simple cholecystectomy[11,17-19,24]	Frailty, nonoperative intent or disseminated disease
8/9	Celiac pathway mapping and selected sampling/clearance	Suspicious nodes, T2/T3 or more advanced disease, or celiac-route concern[4,7,8]	Low-risk early disease without suspicion; no evidence supports routine use
13/17	Retropancreatic pathway mapping and selected assessment	Suspicious retropancreatic nodes, high-risk biology or expert HPB exposure available[4,5,7,20]	If clearance would require disproportionate morbidity or if no R0 operation is possible
14	Mesenteric pathway assessment	Superior mesenteric-root suspicion or disease pattern compatible with this route[4-6]	Routine use without pathway risk or when systemic progression is present
16a2/16b1	Futility assessment by sampling; exceptional investigational clearance	Suspicious convergence-basin disease after response/stability and no occult spread[9,10,21-23]	Progression, new metastases, poor reserve or no realistic R0 resection[9,12-18,23]

The table separates anatomical mapping, staging/sampling and therapeutic clearance. The latter remains investigational and should be discussed only in expert-center multidisciplinary settings. Citations in the table indicate the anatomical, staging or retrospective literature informing each station-specific consideration; they do not establish a therapeutic standard.