{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T12:59:55Z","timestamp":1780145995662,"version":"3.54.0"},"reference-count":26,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2019,3,12]],"date-time":"2019-03-12T00:00:00Z","timestamp":1552348800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Surgical Oncology"],"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of the current study was to identify the minimum number and the optimal range of lymph nodes (LNs) to be examined among patients with gallbladder cancer (GBC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 1, 2004, and December 31, 2015, patients with a diagnosis of GBC were identified in the National Cancer Database. A machine\u2010based learning approach was used to identify the minimum number and range of LNs to evaluate relative to long\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 6531 patients with GBC, median number of LNs evaluated was 2 (IQR:1\u20105); only 21.1% (n\u2009=\u20091376) of patients had 6 or more LNs evaluated. The median number of metastatic LNs was 0 (IQR: 0\u20101). On multivariable analysis, evaluation of\u2009&lt;\u20094 LNs was associated with a higher hazard of death (referent 4\u20107 LNs:\u2009&lt;\u20094 LNs, HR\u2009=\u20091.27, 95% CI, 1.16\u20101.40; <jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001), whereas, patients who had 4 to 7 LNs and\u2009&gt;\u20097 LNs evaluated had comparable long\u2010term mortality risk (HR\u2009=\u20091.10, 95%CI, 0.98\u20101.24; <jats:italic>P<\/jats:italic>\u2009=\u20090.11). There was no difference in the proportion of patients who had at least one metastatic LN identified per T category based on total number of nodes resected (all <jats:italic>P<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The overwhelming majority of patients did not have the American Joint Committee on Cancer (AJCC) recommended 6 total LN count . A machine\u2010based learning approach identified evaluation of 4 to 7 LNs as the LN number associated with optimal staging and survival. While obtaining 6 LNs may be challenging, evaluation of at least 4 LNs may be a more appropriate threshold as this cut\u2010off value was associated with optimal patient outcomes and staging.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jso.25450","type":"journal-article","created":{"date-parts":[[2019,3,13]],"date-time":"2019-03-13T05:10:12Z","timestamp":1552453812000},"page":"1099-1107","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":45,"title":["The optimal number of lymph nodes to evaluate among patients undergoing surgery for gallbladder cancer: Correlating the number of nodes removed with survival in 6531 patients"],"prefix":"10.1002","volume":"119","author":[{"given":"Diamantis I.","family":"Tsilimigras","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. Madison","family":"Hyer","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anghela Z.","family":"Paredes","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5276-0699","authenticated-orcid":false,"given":"Dimitrios","family":"Moris","sequence":"additional","affiliation":[{"name":"Department of Surgery Duke University Medical Center Durham North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliza W.","family":"Beal","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katiuscha","family":"Merath","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rittal","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aslam","family":"Ejaz","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan M.","family":"Cloyd","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy M.","family":"Pawlik","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research Institute Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,3,12]]},"reference":[{"key":"e_1_2_5_1_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/canjclin.51.6.349"},{"key":"e_1_2_5_1_3_1","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-016-5470-2"},{"key":"e_1_2_5_1_4_1","first-page":"99","article-title":"Gallbladder cancer: Epidemiology and outcome","volume":"6","author":"Hundal R","year":"2014","journal-title":"Clin Epidemiol"},{"key":"e_1_2_5_1_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000154118.07704.ef"},{"issue":"5","key":"e_1_2_5_1_6_1","first-page":"452","article-title":"Surgery for gallbladder cancer in the US: a need for greater lymph node clearance","volume":"6","author":"Tran TB","year":"2015","journal-title":"J Gastrointest Oncol"},{"key":"e_1_2_5_1_7_1","volume-title":"American Joint Committee on Cancer: AJCC Cancer Staging Manual","author":"Edge SB","year":"2009"},{"key":"e_1_2_5_1_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31822238d8"},{"key":"e_1_2_5_1_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2008.02.031"},{"key":"e_1_2_5_1_10_1","unstructured":"Network NCC. 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