Distribution of Lymphatic Vessels in the Neural Plexuses Surrounding the Superior Mesenteric Artery

Jin, Gang; Sugiyama, Masanori; Tuo, Hongfang; Oki, Atsuko; Abe, Nobutsugu; Mori, Toshiyuki; Terabe, Masaki; Fujioka, Yasunori

doi:10.1097/01.mpa.0000194607.16982.d7

Cited by 25 publications

(17 citation statements)

References 26 publications

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“…Moreover, several anatomic and pathologic studies have been conducted to identify lymphatic network and high risk areas of lymph node involvement [23-27] and to define the pattern of perineural invasion of pancreatic cancer [27-29]. Concerning lymphatic drainage, a rich communication between the anterior surface of the head of the pancreas, the common hepatic artery, the celiac trunk origin and the superior mesenteric artery was described.…”

Section: Introductionmentioning

confidence: 99%

“…As well as a lymphatic pathway from the body and the tail of pancreas was shown around the splenic blood vessels and the inferior pancreatic artery up to the lymph nodes situated on the left side of the celiac trunk and the superior mesenteric artery [23,24]. The extent of perineural invasion has been also demonstrated in a number of pathologic studies, often showing lymphatic emboli and neural invasions in the soft tissue adherent to the vessels and near to the metastatic nodes [27-29]. The close embryologic development relationship of lymphatic and nervous structures could justify the dual pathway of dissemination of pancreatic cancer along peripancreatic connective tissues [30].…”

Section: Introductionmentioning

confidence: 99%

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Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

et al. 2012

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BackgroundRadiotherapy (RT) is widely used in the treatment of pancreatic cancer. Currently, recommendation has been given for the delineation of the clinical target volume (CTV) in adjuvant RT. Based on recently reviewed pathologic data, the aim of this study is to propose criteria for the CTV definition and delineation including elective nodal irradiation (ENI) in the preoperative and definitive treatment of pancreatic cancer.MethodsThe anatomical structures of interest, as well as the abdominal vasculature were identified on intravenous contrast-enhanced CT scans of two different patients with pancreatic cancer of the head and the body. To delineate the lymph node area, a margin of 10 mm was added to the arteries.ResultsWe proposed a set of guidelines for elective treatment of high-risk nodal areas and CTV delineation. Reference CT images were provided.ConclusionsThe proposed guidelines could be used for preoperative or definitive RT for carcinoma of the head and body of the pancreas. Further clinical investigations are needed to validate the defined CTVs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

et al. 2012

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“…The celiac plexus is located in front of the superior segment of the abdominal aorta, surrounding the celiac trunk and the root of the SMA [34,35] ( Figure 3). At dissection, most of the celiac ganglia were between thoracic 12 and lumbar 1 (T12 and �1), and these…”

Section: The Celiac Plexusmentioning

confidence: 99%

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part I): Anatomy, imaging of the extrapancreatic nerve

Zuo

Zhang²,

Liu³

et al. 2012

WJR

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Pancreatic carcinoma is an extremely high-grade malignant tumor with �ast development and high mortality. The incidence o� pancreatic carcinoma continues to increase. Peripancreatic invasion and metastasis are the main characteristics and important prognostic �actors in pancreatic carcinoma, especially invasion into the nervous system; pancreatic nerve innervation includes the intrapancreatic and extrapancreatic nerves. A strong grasp o� pancreatic nerve innervation may contribute to our understanding o� pancreatic pain modalities and the metastatic routes �or pancreatic carcinomas. Computed tomography (CT) and magnetic resonance imaging (MRI) are help�ul techniques �or depicting the anatomy o� extrapancreatic nerve innervation. The purpose o� the present work is to show and describe the anatomy o� the extrapancreatic neural plexus and to elucidate its characteristics using CT and MRI, drawing on our own previous work and the research findings of others.

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“…As lymphatics (lymph node and lymph vessels) accompany the arteries and are distributed in the surrounding neural plexuses, complete clearance of peripancreatic tissue, including lymphatics and nerve plexus, is necessary for curative resection of the tumor. [1][2][3][4] As this operation is considered a complex procedure, a surgeon is required to be well trained in this specific surgical technique and to possess sufficient anatomic knowledge.Despite a low mortality rate and improvements in perioperative care and operative management, there is still a relatively high complication rate following PD. 5,6 Several studies showed that intraoperative bleeding and red blood cell (RBC) transfusion are serious risk factors of postoperative complications in PD.…”

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confidence: 99%

mentioning

confidence: 99%

Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

Maemura

Mataki

Kurahara

et al. 2014

International Surgery

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During pancreaticoduodenectomy (PD), early ligation of critical vessels such as the inferior pancreaticoduodenal artery (IPDA) has been reported to reduce blood loss. Color Doppler flow imaging has become the useful diagnostic methods for the delineation of the anatomy. In this study, we assessed the utility of the intraoperative Doppler ultrasonography (Dop-US) guided vessel detection and tracking technique (Dop-Navi) for identifying critical arteries in order to reduce operative bleeding. Ninety patients who received PD for periampullary or pancreatic disease were enrolled. After 14 patients were excluded because of combined resection of portal vein or other organs, the remaining were assigned to 1 of 2 groups: patients for whom Dop-Navi was used (n ¼ 37) and those for whom Dop-Navi was not used (n ¼ 39; controls). We compared the ability of Dop-Navi to identify critical vessels to that of preoperative multi-detector computed tomography (MD-CT), using MD-CT data, as well as compared the perioperative status and postoperative outcome between the 2 patient groups. Intraoperative Dop-US was significantly superior to MD-CT in terms of identifying number of vessels and the ability to discriminate the IPDA from the superior mesenteric artery (SMA) based on blood flow velocity. The Dop-Navi patients had shorter operation times (531 min versus 577 min; no significance) and smaller bleeding volumes (1120 mL versus 1590 mL; P , 0.01) than the control patients without increasing postoperative complications. Intraoperative DopNavi method allows surgeons to clearly identify the IPDA during PD and to avoid injuries to major arteries.Key words: Pancreaticoduodenectomy -Doppler ultrasonography -Blood flowmeter P ancreaticoduodenectomy (PD) is a standard treatment for malignant tumor of periampullary and pancreas head. As lymphatics (lymph node and lymph vessels) accompany the arteries and are distributed in the surrounding neural plexuses, complete clearance of peripancreatic tissue, including lymphatics and nerve plexus, is necessary for curative resection of the tumor. [1][2][3][4] As this operation is considered a complex procedure, a surgeon is required to be well trained in this specific surgical technique and to possess sufficient anatomic knowledge.Despite a low mortality rate and improvements in perioperative care and operative management, there is still a relatively high complication rate following PD. 5,6 Several studies showed that intraoperative bleeding and red blood cell (RBC) transfusion are serious risk factors of postoperative complications in PD. 6,7 Recently, several procedures for artery-first approaches such as posterior, uncinated, and mesenteric approach have been introduced for improving perioperative outcomes such as curability and decreasing blood loss and morbidity. [8][9][10][11] Incidentally, it has been well known that early ligation of the inferior pancreaticoduodenal artery (IPDA)-one of the efferent arteries of the pancreas head-considerably reduces intraoperative bleeding and postoperative co...

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Distribution of Lymphatic Vessels in the Neural Plexuses Surrounding the Superior Mesenteric Artery

Cited by 25 publications

References 26 publications

Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

Clinical target volume delineation including elective nodal irradiation in preoperative and definitive radiotherapy of pancreatic cancer

CT and MR imaging patterns for pancreatic carcinoma invading the extrapancreatic neural plexus (Part I): Anatomy, imaging of the extrapancreatic nerve

Clinical Impact of Intraoperative Navigation Using a Doppler Ultrasonographic Guided Vessel Tracking Technique for Pancreaticoduodenectomy

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