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Optimal Lymphadenectomy of the Mesopancreas Based on Fluorescence Imaging During Pancreaticoduodenectomy
- Source :
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 25(5)
- Publication Year :
- 2020
-
Abstract
- Excision of the mesopancreas with lymphadenectomy is an important component of pancreatoduodenectomy. However, the optimal extent of lymphadenectomy remains unclear. Furthermore, accurate description of the mesopancreatic lymphatic pathways is difficult, probably because of the complex anatomy. Intestinal derotation simplifies the anatomy and facilitates both examination of lymphatic flow and the surgical procedure. The aim of this study was to evaluate lymphatic flow in the mesopancreas using indocyanine green fluorescence imaging with an intestinal derotation technique, and to clarify the optimal extent of mesopancreas excision and lymphadenectomy in pancreatoduodenectomy. Indocyanine green solution (2.5 × 10−3 mg) was injected into the pancreatic head parenchyma. After intestinal derotation, the spread of indocyanine green was observed using near-infrared imaging. Participants comprised 10 patients who underwent pancreatoduodenectomy for periampullary neoplasms. With indocyanine green fluorescence imaging, 9 of the 10 patients showed lymphatic flow from the pancreatic head to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery (but not via the second and more distant arteries), with eventual drainage into the paraaortic region. Lymphatic pathways from the pancreatic head were connected to the superior mesenteric artery via the inferior pancreaticoduodenal artery and first jejunal artery. Excision of the mesopancreas with the inferior pancreaticoduodenal artery and first jejunal artery while preserving the second or more distant arteries appears optimal in pancreatoduodenectomy for periampullary malignancies.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Indocyanine Green Solution
030230 surgery
Pancreaticoduodenectomy
03 medical and health sciences
chemistry.chemical_compound
0302 clinical medicine
Pancreatectomy
medicine.artery
medicine
Humans
Superior mesenteric artery
business.industry
Optical Imaging
Gastroenterology
Inferior pancreaticoduodenal artery
Jejunal arteries
Pancreatic Neoplasms
Lymphatic system
medicine.anatomical_structure
chemistry
030220 oncology & carcinogenesis
Lymph Node Excision
Surgery
Lymphadenectomy
Radiology
business
Indocyanine green
Subjects
Details
- ISSN :
- 18734626
- Volume :
- 25
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
- Accession number :
- edsair.doi.dedup.....d82c191a8e2b7d91ae8c3e33db087828