Although the mandated restriction of resident duty hours has had no measurable impact on the quality of patient care and has led to improvements for the current quality of life of residents, there are many concerns with regards to the training of professional, responsible surgeons for the future.

Laparoscopic cholecystectomy for acute cholecystitis should be done immediately after the diagnosis is established because delaying surgery allows inflammation to become more intense, thus increasing the technical difficulty of laparoscopic cholecystectomy.

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Background The AJCC/UICC staging system for gastric cancer incorporates the absolute number of metastatic lymph nodes (N status) and is optimally used when ≥15 nodes are examined. The ratio of metastatic to examined nodes (N ratio) is an effective prognostic tool, but has not been examined in Western patients undergoing primarily D1 lymphadenectomy. Methods 257 patients with gastric adenocarcinoma who underwent gastric resection between 1995 and 2005 at our institution were examined. Novel N ratio intervals were determined using the best cutoff approach (Nr0: N ratio=0 and ≥15 nodes examined; Nr1: 0 ≤ N ratio ≤ 0.3, Nr2: 0.3 < N ratio ≤ 0.7, and Nr3: N ratio > 0.7). Overall survival was examined according to N status and N ratio. Results 83% of patients underwent D1 lymphadenectomy with a median of 14 lymph nodes examined. Overall survival stratified by N status was significantly different in patients with <15 nodes examined compared to those with ≥15 nodes examined. When we stratified N ratio intervals, there was no significant difference in overall survival in patients with <15 vs. ≥15 nodes examined. On multivariate analysis, N ratio but not N status was retained as an independent prognostic factor. Conclusions The use of N status for staging patients undergoing primarily D1 lymphadenectomy results in significant stage migration due to varying numbers of nodes examined. Use of N ratio reduces stage migration and may be a more reliable method of staging such patients.