Topographic anatomy and laparoscopic technique for dissection of no. 6 infrapyloric lymph nodes in gastric cancer surgery

Abstract

We focused on the embryology and topographic anatomy of the infrapyloric lymph region, which is frequently involved in node metastases but technically complicated for dissection in gastric cancer surgery. Gastrointestinal organs possess their own mesenteries composed of double layers of peritoneum that enclose the intermediate adipose layer providing pathways for vessels, nerves, and lymphatic channels. The frontal layer of the mesoduodenum, in which no. 6 infrapyloric nodes lie, directly faces the pancreas and during gestation is overlain by the greater omentum and transverse mesocolon through the membranous connective tissue called the fusion fascia. Therefore, we performed no. 6 node dissection using the following process: (1) we traced out the mesoduodenum by detachment of the greater omentum and transverse mesocolon; (2) we transected the fusion fascia and (3) removed the adipose layer on the anterior face of the pancreas with its included lymph nodes together with the right gastroepiploic and infrapyloric vessels. The described technique is feasible and in keeping with the anatomical logic for oncologically reliable dissection of no. 6 infrapyloric nodes.

Lymphadenectomy along the infrapyloric artery may be dispensable when performing pylorus-preserving gastrectomy for early middle-third gastric cancer

“…6 infrapyloric LN station is considered an important confluence of lymphatic channels draining the distal two-thirds of the stomach [1,8]. The dissection of the no.…”

“…6 lymphadenectomy were described in detail elsewhere [6,8,9]. After surgery, all regional LNs were individually retrieved from the adipose tissue of the surgical specimen.…”

“…The no. 6 nodes were divided into three substations as per our previous report: 6a is adjacent to the RGEA from its first gastric branch to its root; 6v is adjacent to the RGEV, between the root of the RGEA and the confluence of the anterior superior pancreatoduodenal vein, and 6i is located along the IPA [6,8]. Figure 1 shows a representative surgical specimen, demonstrating the infrapyloric lymph station divided into three sections.…”

Anatomical considerations of the infrapyloric artery and its associated lymph nodes during laparoscopic gastric cancer surgery

“…6 lymphadenectomies The surgical setting of our laparoscopic gastrectomies and our procedure for the no. 6 LN dissection has been described previously [2]. After division of the greater omentum, the transverse smesocolon was taken down to identify the confluence of the right gastroepiploic vein (RGEV) and the anterior superior pancreatoduodenal vein (ASPDV).…”

“…6 by the Japanese Gastric Cancer Association (JGCA) [1], is considered an important confluence of lymphatic channels that drain the distal twothirds of the stomach [2][3][4]. Several studies have demonstrated that metastasis to the no.…”