Pictorial dissection review of the lymphatic pathways from the gallbladder to the abdominal para-aortic lymph nodes and their relationships to the surrounding structures.

PURPOSE: This photographic review of actual dissections was compiled to demonstrate the various lymphatic pathways and their relationships to the surrounding structures to facilitate the development of QOL surgical procedures.
METHODS: For the purpose of demonstration, three male adult specimens, prepared with 10% formaldehyde solution injected through the femoral artery and preserved in 60% alcohol solution, were used. Dissection was carried out in typical fashion without the use of dyes or a microscope. The dissection results were recorded in sketches, photographs and video recording.
RESULTS: Two major lymphatic pathways from the gallbladder are demonstrated: (a) the left oblique pathway to the celiac nodes, and (b) the right descending pathway to the superior retropancreaticoduodenal node (Rouvière). A third and minor pathway to the superior mesenteric nodes is suggested.
CONCLUSIONS: These three pathways finally reach the para-aortic (lumbar) lymph nodes. The importance of the interaorticocaval nodes at the level of the left renal vein should be emphasized, in particular the significance of the nodes of the right descending pathway, from the viewpoint of surgical treatment of cancer of the gallbladder and the pancreas head.