Double inferior vena cava: a crucial finding complicating para-aortic lymphadenectomy

Double inferior vena cava does not complicate para-aortic nodal dissection for the treatment of pancreatic carcinoma

“…According to TNM classification [13] para-aortic lymph nodes are regional lymph nodes for gynecological carcinomas: lymphatics which flow from the ovary, endometrium or cervix uteri reach the abdomino-pelvic lymph nodes running together with the respective blood vessels. In case of double IVC, venous outflow from the left side of the pelvis drains mainly into the left IVC, and venous blood flow from the right side of the pelvis drains into the right IVC; [14] then for radical dissection in patients with gynecological carcinomas and double IVC, a bilateral para-aortic lymphadenectomy including the area of the left IVC is necessary. [2,3,14] In the absence of caval anatomic anomalies, the highest incidence of para-aortic nodal metastasis in cancer of the head of the pancreas has been shown to be in the inter-aortocaval and pre-aortic 16a2 and 16b1 areas; in particular the 16b1 inter-aortocaval segment is considered to be the most important site in the early stage of para-aortic metastasis.…”

“…In case of double IVC, venous outflow from the left side of the pelvis drains mainly into the left IVC, and venous blood flow from the right side of the pelvis drains into the right IVC; [14] then for radical dissection in patients with gynecological carcinomas and double IVC, a bilateral para-aortic lymphadenectomy including the area of the left IVC is necessary. [2,3,14] In the absence of caval anatomic anomalies, the highest incidence of para-aortic nodal metastasis in cancer of the head of the pancreas has been shown to be in the inter-aortocaval and pre-aortic 16a2 and 16b1 areas; in particular the 16b1 inter-aortocaval segment is considered to be the most important site in the early stage of para-aortic metastasis. [15] The study by Deki and Sato on minute dissection of four adult cadavers showed that the lymphatics of the anterior surface of the head of the pancreas and the lymphatics of the neck of the pancreas through different pathways terminate in lymphonodus celiacomesentericus dexter superficialis which is situated to the right of the origins of the celiac trunk and the superior mesenteric artery and is connected with lymphonodus celiacomesentericus dexter profundus: this last, which is found behind the former, receiving the lymphatics which arise from the posterior surface of the pancreatic head, drains almost all vessels derived from the right half of the pancreas.…”