Anatomoclinical and anatomosurgical essay on the lymphatic circulation of the pancreas

Abstract

This essay is based on the injection and dissection of 100 cadaver specimens (fetuses, new borns and infants), the study of 34 case reports of pancreatic carcinoma, the injection of the lymphatic system in 14 living dogs and the reconstruction of the dorsal mesentery of an embryo of 30 mm according to Born's method. The results are as follows: the anatomy of the pancreas and of the lymphatic channels show that there are two distinct portions, one is right-sided and corresponds to the primitive ventral bud, the other is situated on the left and corresponds to the primitive dorsal bud. The primitive dorsal mesentery is formed by a double contingent: one right, for the right pancreas, this is the retroportal process (RPP). The other left, for the left pancreas. This is a formation which up until now, has never been described in the literature, the left lateral portal process (LLPP). While the anterior lymphatic drainage of the pancreas does not seem to hold any surprises, the posterior lymphatic drainage, arising from the posterior and anterior surfaces of the pancreas, is very particular. In the right side (anterior and posterior aspects), the drainage runs to the RPP, while in the left side (anterior and posterior aspects) it courses to the LLPP and here, in an exclusive manner. Only a few borderline regions, those situated precisely in the area of inosculation of the two buds, escape this systematisation. The terminal network of the pancreatic lymphatic channels have a short distance to bridge in order to reach the thoracic duct. The study of the distribution of lymph node metastases in carcinoma of the pancreas seems to confirm the anatomical results in the cadaver, but our series is too short to be of statistical value. Very early spread via the thoracic duct probably greatly reduces the value of supra-enlarged operations whose justification is precisely more complete lymph node removal. It might be useful, however, if proof could be provided that tumor reduction in the case of carcinoma of the pancreas is a necessary prelude to complementary therapeutic measures. The anatomy of the pancreas and of the lymphatic channels in mammals seems to confirm the results found in man, i.e. the division of the pancreas into a right and a left pancreas. The precise knowledge of the anatomy of the lymphatic ducts of the pancreas might be the starting point for progress in the experimental studies concerning the modifications of the lymphatic circulation during acute pancreatitis.(ABSTRACT TRUNCATED AT 400 WORDS)

Is Radical Antegrade Modular Pancreatosplenectomy the Solution? A Systematic Literature Review and Meta-Analysis

“…It showed a difference of 6.54 in favor of the RAMPS group with a p<0.00001. Pancreatic lymph node drainage pathways and mapping are of interest for a long time (22)(23)(24)(25)(26)(27)(28). Previous studies and new data were included and described in detail in O'Morchoe's paper (3).…”

Gastrointestinal lymphatics in health and disease

“…Pissas et al [136] describe two divisions of lymph vessels of the pancreas: a " primary mesodorsal region " of the pancreas composed of the right side retroportal process and a left side lateroportal process. Pancreatic terminal collecting lymphatics in the pancreas are short, merging near the origin of the thoracic duct.…”

“…Pancreatic lymph flow increases in acute pancreatitis [197], with elevation in amylase and lipases in the thoracic duct. Dupont & Litvine [198], Pissas et al, [136] and O’Morchoe et al [137] have described pancreatitis as having an important lymphatic component, where lymphatic failure to clear edema fluid leads to accumulation of exocrine secretions and pancreatic injury. Obstruction of the cisterna chyli will also increase pancreatic edema and exacerbate forms of pancreatitis.…”

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