{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:06:30Z","timestamp":1791432390550,"version":"4.3.3"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T00:00:00Z","timestamp":1613088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Utility of the sentinel lymph node (SLN) biopsy in some malignancies has been reported, however, research on that of gallbladder cancer (GBC) is rare. The aim of this study is to investigate whether the concept of SLN is applicable to T2\/3 GBC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>A total of 80 patients who underwent resection for gallbladder cancer were enrolled in this study. Patients with GBC were stratified into two groups based on the location of tumor, peritoneal-side (T2p or 3p) and hepatic-side (T2h or 3h) groups. We evaluated the relationship between cystic duct node (CDN) and downstream lymph node (LN) status. CDN was defined as a SLN in this study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Thirty-eight patients were classified into T2, including T2p (n = 18) and T2h (n = 20), and 42 patients into T3, including T3p (n = 22) andT3h (n = 20). The incidence of LN metastasis was significantly higher in hepatic-side than peritoneal-side in both T2 and T3 (P = 0.036 and 0.009, respectively). In T2, 14 T2p had negative CDN and downstream LN, however, three T2h had negative CDN and positive downstream LNs (defined as a skipped LN metastasis) (P = 0.043). In T3, patients with skipped LN metastasis were significantly higher in T3h (n = 11) than those in T3p (n = 2) (P&lt;0.001). There was no recurrence of the local lymph node. Disease-free survival in the T2p and T3p were significantly better than those in the T2h and T3h (P = 0.005 and 0.025, respectively).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The concept of SLN can be applicable to T2p GBC, where the downstream LNs dissection can be omitted.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0247079","type":"journal-article","created":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T21:48:37Z","timestamp":1613166517000},"page":"e0247079","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":15,"title":["Applicability of sentinel lymph node oriented treatment strategy for gallbladder cancer"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3643-0921","authenticated-orcid":true,"given":"Koya","family":"Yasukawa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Shimizu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Motoyama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Kubota","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Notake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Sugenoya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kiyotaka","family":"Hosoda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hikaru","family":"Hayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryoichiro","family":"Kobayashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Soejima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,2,12]]},"reference":[{"key":"pone.0247079.ref001","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1002\/jso.20885","article-title":"Management of carcinoma of the gallbladder: a single-institution experience in 16 years","volume":"97","author":"SY Chan","year":"2008","journal-title":"J Surg Oncol"},{"key":"pone.0247079.ref002","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1007\/s11605-007-0181-4","article-title":"A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma","volume":"11","author":"M Kai","year":"2007","journal-title":"J Gastrointest Surg"},{"key":"pone.0247079.ref003","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1097\/SLA.0b013e3181675842","article-title":"What is an adequate extent of resection for T1 gallbladder cancers?","volume":"247","author":"DD You","year":"2008","journal-title":"Ann Surg"},{"key":"pone.0247079.ref004","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4253\/wjge.v12.i4.119","article-title":"Burgeoning study of sentinel-node analysis on management of early gastric cancer after endoscopic submucosal dissection","volume":"12","author":"D Friedel","year":"2020","journal-title":"World J Gastrointest Endosc"},{"key":"pone.0247079.ref005","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1007\/s10549-020-05636-z","article-title":"Axillary lymph node dissection is not obligatory in breast cancer patients with biopsy-proven axillary lymph node metastasis","volume":"181","author":"TK Yoo","year":"2020","journal-title":"Breast Cancer Res Treat"},{"key":"pone.0247079.ref006","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ajog.2016.11.1033","article-title":"Sentinel lymph node assessment in endometrial cancer: a systematic review and meta-analysis","volume":"216","author":"AJ Bodurtha Smith","year":"2017","journal-title":"Am J Obstet Gynecol"},{"key":"pone.0247079.ref007","doi-asserted-by":"crossref","DOI":"10.1093\/jncics\/pkz052","article-title":"Long-Term Outcomes of Sentinel Lymph Node Biopsy for Ductal Carcinoma in Situ","volume":"3","author":"P Hung","year":"2019","journal-title":"JNCI Cancer Spectr"},{"key":"pone.0247079.ref008","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/j.ejso.2015.12.007","article-title":"A systematic review and meta-analyses of sentinel lymph node identification in breast cancer and melanoma, a plea for tracer mapping","volume":"42","author":"M.G. 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Extension of the LND and Prognostic Value of the Lymph Node Ratio","volume":"22","author":"DJ Birnbaum","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"pone.0247079.ref019","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1245\/s10434-017-5939-7","article-title":"Relevance of Dissection of the Posterior Superior Pancreaticoduodenal Lymph Nodes in Gallbladder Carcinoma","volume":"24","author":"J Sakata","year":"2017","journal-title":"Ann Surg Oncol"},{"key":"pone.0247079.ref020","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1002\/bjs.10913","article-title":"Extent of LND in patients with gallbladder cancer","volume":"105","author":"Y Kishi","year":"2018","journal-title":"Br J Surg"},{"key":"pone.0247079.ref021","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/s11605-017-3507-x","article-title":"Extended Lymphadenectomy Is Required for Incidental Gallbladder Cancer Independent of Cystic Duct Lymph Node Status","volume":"22","author":"EA Vega","year":"2018","journal-title":"J Gastrointest Surg"},{"key":"pone.0247079.ref022","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1097\/PAS.0b013e3181c467d4","article-title":"Mode of hepatic spread from gallbladder carcinoma: an immunohistochemical analysis of 42 hepatectomized specimens","volume":"34","author":"T Wakai","year":"2010","journal-title":"Am J Surg Pathol"},{"key":"pone.0247079.ref023","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1097\/SLA.0000000000000728","article-title":"Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study","volume":"261","author":"J Shindoh","year":"2015","journal-title":"Ann Surg"},{"key":"pone.0247079.ref024","doi-asserted-by":"crossref","first-page":"2779","DOI":"10.1245\/s10434-014-4300-7","article-title":"Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location","volume":"22","author":"H Lee","year":"2015","journal-title":"Ann Surg Oncol"},{"key":"pone.0247079.ref025","doi-asserted-by":"crossref","first-page":"140","DOI":"10.5009\/gnl15080","article-title":"Effects of Surgical Methods and Tumor Location on Survival and Recurrence Patterns after Curative Resection in Patients with T2 Gallbladder Cancer","volume":"10","author":"W Jung","year":"2016","journal-title":"Gut and Liver"},{"key":"pone.0247079.ref026","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.surg.2017.05.004","article-title":"Do hepatic-sided tumors require more extensive resection than peritoneal-sided tumors in patients with T2 gallbladder cancer? Results of a retrospective multicenter study","volume":"162","author":"W Lee","year":"2017","journal-title":"Surgery"},{"key":"pone.0247079.ref027","first-page":"4427","article-title":"Prognostic validation of the updated 8th edition Tumor\u2011Node\u2011Metastasis classification by the Union for International Cancer Control: Survival analyses of 307 patients with surgically treated gallbladder carcinoma","volume":"16","author":"L Wang","year":"2018","journal-title":"Oncol Lett"},{"key":"pone.0247079.ref028","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4174\/astr.2018.94.3.135","article-title":"The optimal surgical resection approach for T2 gallbladder carcinoma: evaluating the role of surgical extent according to the tumor location","volume":"94","author":"TJ Park","year":"2018","journal-title":"Ann Surg Treat Res"},{"key":"pone.0247079.ref029","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12957-018-1556-6","article-title":"Validation of the oncologic effect of hepatic resection for T2 gallbladder cancer: a retrospective study","volume":"17","author":"JK Cho","year":"2019","journal-title":"World J Surg Oncol"},{"key":"pone.0247079.ref030","first-page":"1073274820915514","article-title":"Clinicopathological Differences in T2 Gallbladder Cancer According to Tumor Location","volume":"27","author":"W Kim","year":"2020","journal-title":"Cancer Control"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0247079","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,12]],"date-time":"2021-02-12T21:49:00Z","timestamp":1613166540000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0247079"}},"subtitle":[],"editor":[{"given":"Mitesh J.","family":"Borad","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,2,12]]},"references-count":30,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0247079","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,12]]}}}