Location of the meso-pancreatoduodenum as a regional lymphatic basin for pancreatic head carcinoma

Terakawa,Hirofumi; Kitagawa,Hirohisa; Makino,Isamu; Hayashi,Hironori; Oyama,Katsunobu; Nakagawara,Hisatoshi; Miyashita,Tomoharu; Tajima,Hidehiro; Takamura,Hiroyuki; Fushida,Sachio; Ozaki,Noriyuki; Ohta,Tetsuo

doi:10.3892/ol.2017.6138

Location of the meso-pancreatoduodenum as a regional lymphatic basin for pancreatic head carcinoma

Authors:
- Hirofumi Terakawa
- Hirohisa Kitagawa
- Isamu Makino
- Hironori Hayashi
- Katsunobu Oyama
- Hisatoshi Nakagawara
- Tomoharu Miyashita
- Hidehiro Tajima
- Hiroyuki Takamura
- Sachio Fushida
- Noriyuki Ozaki
- Tetsuo Ohta
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Affiliations: Department of Gastroenterologic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa 920‑8641, Japan, Department of Functional Anatomy, Graduate School of Medical Science, Kanazawa University, Kanazawa 920‑8641, Japan
Published online on: May 9, 2017 https://doi.org/10.3892/ol.2017.6138
Pages: 397-403

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Abstract

The meso-pancreatoduodenum is the primary site of tumor infiltration in patients with pancreatic head cancer, with numerous patients exhibiting lymph node metastases. Effective dissection of the regional lymphatic basin requires knowledge of the patterns of the arterial branches. The present study examined the patterns of the arteries feeding the pancreatic head and the distribution of the meso‑pancreatoduodenum. The present study included 123 patients with pancreatic cancer who underwent contrast‑enhanced preoperative 64‑multidetector‑computed tomography to determine the routes of the inferior pancreaticoduodenal and first jejunal arteries. Surgical specimens and cadavers were also evaluated histologically to clarify the distribution of the meso‑pancreatoduodenum. The feeding arteries were divided into three types, with 64.2% of patients having type A, 28.4% having type B and 7.3% having type C branches. The branches emerged from the back or left side of the superior mesenteric artery and ran to the far side of the pancreatic head in an arc. Consequently, the meso‑pancreatoduodenum had a roll‑shaped appearance, surrounding the trunk arteries and extending to the left side of the superior mesenteric artery. Dissecting the right and left sides of the superior mesenteric artery during lymphadenectomy could improve the effectiveness of resection.

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