Identification of the Lymphatic Drainage Pathways from the Pancreatic Head Guided by Indocyanine Green Fluorescence Imaging during Pancreaticoduodenectomy
Digestive Surgery, 04/24/2012
Hirono S et al. – Authors found that several lymphatic drainage routes were observed from the pancreatic head, suggesting that a lymphadectomy around the SMA might have a similar oncological impact as that of the PA region.Methods
- The lymphatic pathways in 20 patients undergoing pancreaticoduodenectomy were analyzed.
- They injected ICG into the parenchyma in the anterior (n = 10) or posterior surface (n = 10) of the pancreas head and observed the intraoperative lymphatic flows by ICG fluorescence imaging.
- The seven main lymphatic drainage pathways were identified:
- Along the anterior or posterior pancreaticoduodenal arcade,
- Running obliquely down behind the superior mesenteric vein (SMV),
- Reaching the left side of the superior mesenteric artery (SMA),
- Running longitudinally upward between the SMV and SMA,
- Along the middle colic artery toward the transverse colon,
- Reaching the paraaortic (PA) region,
- Reaching the hepatoduodenal ligament.
- The lymphatic pathway reaching the left side of the SMA was observed in 4 patients (20%), while that reaching the PA region in 17 patients (85%).
- The mean time to reach around the SMA was longer than that to reach the PA region.