Surgical Anatomy of the Superior Mesenteric Vessels Related to Colon and Pancreatic Surgery: A Systematic Review and Meta-Analysis

Abstract

The surgeon dissecting the base of the mesenterium, around the superior mesenteric vein (SMV) and artery, is facing a complex tridimensional vascular anatomy and should be aware of the anatomical variants in this area. The aim of this systematic review is to propose a standardized terminology of the superior mesenteric vessels, with impact in colon and pancreatic resections. We conducted a systematic search in PubMed/MEDLINE and Google Scholar databases up to March 2017. Forty-five studies, involving a total of 6090 specimens were included in the present meta-analysis. The pooled prevalence of the ileocolic, right colic and middle colic arteries was 99.8%, 60.1%, and 94.6%, respectively. The superior right colic vein and Henle trunk were present in 73.9%, and 89.7% of specimens, respectively. In conclusion, the infra-pancreatic anatomy of the superior mesenteric vessels is widely variable. We propose the term Henle trunk to be used for any venous confluence between gastric, pancreatic and colic veins, which drains between the inferior border of the pancreas and up to 20 mm downward on the right-anterior aspect of the SMV. The term gastrocolic trunk should not be synonymous, but a subgroup of the Henle trunk, together with to gastropancreatocolic, gastropancreatic, or colopancreatic trunk.

Platelet-to-lymphocyte ratio and CA19-9 are simple and informative prognostic factors in patients with resected pancreatic cancer

“…continues to be one of the most lethal human malignancies [3][4][5][6]. There are significant efforts in the fundamental and clinical research to find genetic and epigenetic biomarkers with increased accuracy to guide therapy in patients with PDAC [7,8].…”

Response of the Authors to the Letter of the Editor Surgical Anatomy of the Superior Mesenteric Vessels Related to Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis

“…1,4 We agree about the importance of the PSPDV as an anatomical landmark during portal vein surgical dissection. On the other hand, during pancreaticoduodenectomy, we try to maintain the venous drainage of the surgical specimen after transection of the inferior pancreaticoduodenal artery, to prevent specimen congestion, oozing and a bloody surgical field.…”

Value of the surgeon’s sightline on hologram registration and targeting in mixed reality

“…In this way, MR devices have the potential to facilitate the introduction of complex surgical procedures, which the surgical community is typically reluctant to implement, as standard treatment options [13]. The ultimate goals are to both avoid devastating vascular injuries and to improve overall outcomes in cancer patients [12,19].…”

“…In bowel cancer surgery, the fatty tissue connecting the bowel to the body (the mesentery) contains all of these pathways together with vital blood vessels, which are mostly concealed by the thickness of the fat [11]. This visual obstacle is the main reason why most of the compromises in quality of surgery are made, due to higher risks for bleedings and other complications [12]. Yet, the growing body of scientific evidence states that more extensive surgery (e.g., extended lymphadenectomy) can provide better disease-free survival for patients [13,14].…”