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

Figure 2 Original intraoperative images illustrating pathway-aware lymphadenectomy and associated radical surgical steps in selected gallbladder cancer. A: Original anonymized intraoperative image showing hepatoduodenal ligament skeletonization and arterial landmarks during extended hepatobiliary lymphadenectomy after neoadjuvant therapy. The panel supports the discussion of the hepatoduodenal/celiac route; B: Original anonymized intraoperative image illustrating retropancreatic/para-aortic nodal tissue harvesting. The panel supports the conceptual discussion of retropancreatic exposure and convergence-basin assessment, and is not presented as a routine indication; C: Original anonymized intraoperative image of hepatic radicalization involving segments 4b and 5. This panel documents the liver component accompanying selected R0-intent surgery and is not presented as a lymphadenectomy panel; D: Original anonymized image of hepatic radicalization specimen. It is included to show the resection component paired with nodal assessment in selected cases; E: Original anonymized image of en bloc nodal tissue corresponding to stations 12, 8 and 9. This panel supports the concept of station-specific specimen reporting. Original image from the authors’ surgical experience. Reproduced courtesy of the General Surgery Unit, Enna Hospital, with written patient consent and institutional authorization. RHA: Right hepatic artery; LHA: Left hepatic artery; CHA: Common hepatic artery; LGA: Left gastric artery; SA: Splenic artery; CA: Celiac axis.