Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread

Kitagawa, Hirohisa; Ohta, Tetsuo; Makino, Isamu; Tani, Takashi; Tajima, Hidehiro; Nakagawara, Hisatoshi; Takamura, Hiroyuki; Kayahara, Masato; Watanabe, Hiroyuki; Gabata, Toshifumi; Matsui, Osamu; Zen, Yoh

doi:10.2741/2880

Cited by 43 publications

(38 citation statements)

References 14 publications

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“…2. In these specimens, removal of the duodenum, pancreatic head, bile duct, SMV, SMA and surrounding connective tissue by en bloc resection allowed for the determination of the lymphatic route between the area surrounding the SMA and the pericholedochal area (9).…”

Section: Resultsmentioning

confidence: 99%

“…Between 1997 and 2005, a total of 58 patients underwent PD for invasive pancreatic ductal cancer in the Department of Gastroenterologic Surgery at Kanazawa University. Among these cases, radical PD with major vessel resection [superior mesenteric artery (SMA) and superior mesenteric vein (SMV) resection] was performed in 18 patients for complete clearance of the soft tissues around these arteries (9). This study was approved by the Ethics Committee at our institution and was conducted in accordance with the Declaration of Helsinki.…”

Section: Methodsmentioning

confidence: 99%

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Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

Nakagawara

Tajima

Miyashita

et al. 2014

Molecular and Clinical Oncology

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Abstract. Lymph node metastasis from gallbladder cancer is often found in the pericholedochal area; however, these regional lymph nodes are not typically accompanied by arteries. We hypothesized that the artery accompanying pericholedochal lymph nodes was either the regressed embryonic right hepatic artery (eRHA) or an aberrant right hepatic artery (aRHA) remaining without regression. This study aimed to determine the artery supplying pericholedochal lymph nodes. We obtained serial tissue sections of resected specimens from 10 patients who underwent pancreaticoduodenectomy with combined resection of the superior mesenteric artery and vein and investigated the association between the distribution of enlarged lymph nodes and the course of blood vessels in each section. In 2 cases with aRHA, enlarged lymph nodes were distributed in the posterosuperior area, pancreaticoduodenal region and retroportal area along this artery. By contrast, no blood vessels accompanied enlarged lymph nodes in 8 patients exhibiting a normal hepatic artery branching pattern, although these nodes exhibited a distribution pattern similar to that of patients with the aRHA. Thus, the artery supplying pericholedochal lymph nodes appears to be either the regressed eRHA or an aRHA persisting without regression. IntroductionThe prognosis of gallbladder cancer (GBC) with lymph node metastases is poor. The 5-year survival rate following surgical resection has been reported to be 65% for patients with no lymph node metastases and <30% for those with regional lymph node metastases (pN1) (1). In the pN1 group, lymph node metastases characteristically arise in the pericholedochal area or the posterosuperior pancreaticoduodenal region, rather than around the hepatic artery (2,3). However, no feeding arteries are present around the pericholedochal lymph nodes and posterosuperior pancreaticoduodenal lymph nodes (PPLNs), although lymph nodes and lymphatic vessels generally exist along a feeding artery (4-7).We previously performed pancreaticoduodenectomy (PD) for pancreatic cancer in patients with an aberrant right hepatic artery (aRHA). In such cases, PPLNs were distributed along the aRHA. This artery is considered to represent an embryonic right hepatic artery (eRHA) that has not regressed. We hypothesized that the artery responsible for PPLNs would be the eRHA. If this hypothesis is accurate, lymphadenectomy for GBC should be performed based on the course of the eRHA (8). The aim of this study was to determine the artery supplying the PPLNs. Materials and methodsPatients. Between 1997 and 2005, a total of 58 patients underwent PD for invasive pancreatic ductal cancer in the Department of Gastroenterologic Surgery at Kanazawa University. Among these cases, radical PD with major vessel resection [superior mesenteric artery (SMA) and superior mesenteric vein (SMV) resection] was performed in 18 patients for complete clearance of the soft tissues around these arteries (9). This study was approved by the Ethics Committee at our institution and was conducted ...

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

Nakagawara

Tajima

Miyashita

et al. 2014

Molecular and Clinical Oncology

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“…Collagen fibers, forming two fibrous bunches, were observed regularly in the soft tissue. Around the SMA, which was covered grossly by fibrous tissue, collagen fibers formed concentric circles ~3 mm thick, a structure called the superior mesenteric arterial plexus (PLsma) (12). By contrast, collagen fibers near the uncinated process ran vertically from the uncinated process of the pancreas to the PLsma, with continuity through the posterior and left side of the SMA (Fig.…”

Section: Resultsmentioning

confidence: 99%

“…We previously determined that the manner of lymphatic extension and nerve plexus infiltration of the PHC were dependent on whether the tumor originated from the embryonic dorsal or ventral pancreatic bud (12,13). Tumors confined to the ventral pancreas extend toward the SMA, whereas tumors confined to the dorsal pancreas extend towards the common HA or hepatoduodenal ligament.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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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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“…Namely, when the tumor is confined to the ventral pancreas domain, lymph node metastases were limited to areas with the superior mesenteric artery besides peripancreatic lymph nodes. When the tumor was in the dorsal pancreas domain, the lymph node metastases were limited to areas along the common hepatic artery and the hepatoduodenal ligament besides peripancreatic lymph nodes [30]; therefore, it is suggested that, during embryonic development, the ventral and dorsal pancreatic anlagen are irrigated by the superior mesenteric artery and celiac trunk, respectively.…”

Section: Discussionmentioning

confidence: 99%

Anterior Inferior Pancreaticoduodenal Artery Running Between the Dorsal and Ventral Pancreas: Morphological and Embryological Viewpoint

Yi²,

Wang³

et al. 2010

Open Anat J

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Abstract:Objective: To elucidate the configurational relationship of the anterior inferior pancreaticoduodenal artery (AIPD) and embryological ventral/dorsal pancreas anlagen.Methods: 64 cadavers were used for morphological observation by gross dissection of the head and uncinate process of the pancreas as well as its vessels. The localization of pancreatic polypeptide-immunoreactive cells was investigated in 22 cadaveric pancreas samples.Results: In 73.4% subjects, the AIPD appeared not on the anterior surface of the anterior inferior portion of the pancreatic head, but was covered by pancreatic parenchyme. The islets of Langerhans were irregular in shape, and abundant pancreatic polypeptide-immunoreactive cells were identified in the pancreatic tissues of the posterior region of the AIPD, while in the anterior region of the AIPD, the islets of Langerhans were rounded, and few or no pancreatic polypeptideimmunoreactive cells were identified. Conclusions:The AIPD may follow the boundary between the dorsal and ventral pancreas, and we can interpret in embryology of the morphological characteristics by which the AIPD is located behind or on the anterior surface of the anterior inferior portion of the pancreatic head.

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Carcinomas of the ventral and dorsal pancreas exhibit different patterns of lymphatic spread

Cited by 43 publications

References 14 publications

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

Lymph node spread of gallbladder cancer from the perspective of embryologically-based anatomy and significance of the lymphatic basin along the embryonic right hepatic artery

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

Anterior Inferior Pancreaticoduodenal Artery Running Between the Dorsal and Ventral Pancreas: Morphological and Embryological Viewpoint

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