{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:46:00Z","timestamp":1777448760295,"version":"3.51.4"},"reference-count":34,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gallbladder cancer (GBC) is the most common biliary tract malignancy and has a poor prognosis. The clinical significance of focal vs diffuse GBC remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective review was conducted on all patients with non-metastatic GBC at a quaternary care center. Pathology was reviewed, and gallbladder cancer pattern was defined based on the extent of mucosal involvement; \u201cdiffuse\u201d if the tumor was multicentric or \u201cfocal\u201d if the tumor was only in a single location. Patients undergoing liver resection and portal lymphadenectomy were considered to have definitive surgery. The primary outcome was overall survival and assessed by Kaplan-Meier curves.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>63 patients met study criteria with 32 (50.7%) having diffuse cancer. No difference was observed in utilization of definitive surgery between the groups (14 [43.8%] with focal and 12 [38.7%] with diffuse, P = .88). Lymphovascular invasion ( P = .04) and higher nodal stage ( P = .04) were more common with diffuse GBC. Median overall survival was significantly improved in those with focal cancer (5.1 vs 1.2\u00a0years, P = .02). Although not statistically significant, this difference in overall survival persisted in patients who underwent definitive surgery (4.3 vs 2.4\u00a0years, P = .70).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Patients with diffuse involvement of the gallbladder mucosa likely represent a subset with aggressive biology and worse overall survival compared to focal disease. These findings may aid surgeons in subsequent surgical and medical decision-making for patients with GBC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348231220581","type":"journal-article","created":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T07:07:26Z","timestamp":1704352046000},"page":"1133-1139","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Intramucosal Extent as a Marker for Advanced Disease and Survival in Gallbladder Adenocarcinoma"],"prefix":"10.1177","volume":"90","author":[{"given":"Robert","family":"Naples","sequence":"first","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Breanna C.","family":"Perlmutter","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haiyan","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniela","family":"Allende","sequence":"additional","affiliation":[{"name":"Department of Pathology, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Cleveland Clinic Learner Research Institute, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asif","family":"Hitawala","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fairview Hospital, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pravallika","family":"Chadalavada","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fairview Hospital, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay","family":"Padbidri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Fairview Hospital, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdo","family":"Haddad","sequence":"additional","affiliation":[{"name":"Department of Hematology Oncology, Fairview Hospital, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Matthew","family":"Walsh","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toms","family":"Augustin","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2024,1,4]]},"reference":[{"key":"bibr1-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdn533"},{"key":"bibr2-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2010.05.002"},{"issue":"27","key":"bibr3-00031348231220581","first-page":"1529","volume":"46","author":"Lowenfels AB","year":"1999","journal-title":"Hepatogastroenterology"},{"key":"bibr4-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1002\/jso.21141"},{"key":"bibr5-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-011-1134-3"},{"key":"bibr6-00031348231220581","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v21.i43.12211"},{"key":"bibr7-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1111\/hpb.12444"},{"key":"bibr8-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31806beec2"},{"key":"bibr9-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2009.00108.x"},{"key":"bibr10-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1002\/jhbp.870"},{"key":"bibr11-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1245\/s10434-008-0189-3"},{"key":"bibr12-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2016.12.058"},{"key":"bibr13-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2200015"},{"key":"bibr14-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2022.10.506"},{"key":"bibr15-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30915-X"},{"key":"bibr16-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-011-1528-4"},{"key":"bibr17-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1245\/ASO.2004.03.011"},{"key":"bibr18-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2011.03.135"},{"key":"bibr19-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e318216f5f3"},{"key":"bibr20-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1002\/jso.25186"},{"key":"bibr21-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1002\/jso.26160"},{"key":"bibr22-00031348231220581","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v18.i22.2775"},{"key":"bibr23-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2010.09.009"},{"key":"bibr24-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2009.46"},{"key":"bibr25-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2013.02.010"},{"key":"bibr26-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-021-04942-1"},{"key":"bibr27-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1007\/s11605-019-04389-5"},{"key":"bibr28-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2019.01.013"},{"key":"bibr29-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000219737.81943.4e"},{"key":"bibr30-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31818a1561"},{"key":"bibr31-00031348231220581","doi-asserted-by":"publisher","DOI":"10.21037\/cco.2019.06.06"},{"key":"bibr32-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2017.02.006"},{"key":"bibr33-00031348231220581","doi-asserted-by":"publisher","DOI":"10.4143\/crt.2019.271"},{"key":"bibr34-00031348231220581","doi-asserted-by":"publisher","DOI":"10.1002\/cam4.2989"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231220581","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348231220581","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348231220581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T12:38:52Z","timestamp":1777379932000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348231220581"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,4]]},"references-count":34,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["10.1177\/00031348231220581"],"URL":"https:\/\/doi.org\/10.1177\/00031348231220581","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,4]]}}}