T Bardol1,2, G Subsol3, M-J Perez4, D Genevieve4,5,6, A Lamouroux7, B Antoine4, G Captier8,9, M Prudhomme10,11, M M Bertrand10,11. 1. Laboratory of Experimental Anatomy Faculty of Medicine Montpellier-Nimes, University Montpellier, 30 rue Lunaret, 34090, Montpellier, France. thomas.bardol@gmail.com. 2. Visceral and Digestive Surgery Department, CHU de Nimes, University Montpellier 1, Nîmes, France. thomas.bardol@gmail.com. 3. Research-Team ICAR, LIRMM CNRS, University of Montpellier, Montpellier, France. 4. Department of Medical Genetics, Reference Center for Developmental Abnormalities and Constitutional Bone Diseases, CHRU, Montpellier, France. 5. Genetics and Immunopathology of Inflammatory Osteoarticular Diseases, INSERM UMR1183, Montpellier, France. 6. University of Montpellier, Montpellier, France. 7. Obstetrics and Gynecology Department, Nîmes University Hospital, Nîmes, France. 8. Department of Plastic and Craniofacial Pediatric Surgery, Lapeyronie University Hospital, Avenue Du Doyen Gaston Giraud, Montpellier, France. 9. Epidemiological Biostatistics and Clinical Research Laboratory, EA2415, University of Montpellier, Montpellier, France. 10. Laboratory of Experimental Anatomy Faculty of Medicine Montpellier-Nimes, University Montpellier, 30 rue Lunaret, 34090, Montpellier, France. 11. Visceral and Digestive Surgery Department, CHU de Nimes, University Montpellier 1, Nîmes, France.
Abstract
PURPOSE: Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment. METHODS: We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin-eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions. RESULTS: We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body-tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly. CONCLUSION: In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.
PURPOSE:Pancreatic cancer is the fourth cause of death by cancer worldwide. Lymph node (LN) involvement is known to be the main prognostic factor. However, lymphatic anatomy is complex and only partially characterized. The aim of the study was to study the pancreatic lymphatic system using computer-assisted anatomic dissection (CAAD) technique and also to update CAAD technique by automatizing slice alignment. METHODS: We dissected three human fetuses aged from 18 to 34 WA. 5-µm serial sections of duodeno-pancreas and spleen blocks were stained (hematoxylin-eosin, hematoxylin of Mayer and Masson trichrome), scanned, aligned and modeled in three dimensions. RESULTS: We observed a rich, diffuse but not systematized lymphatic network in the peri-pancreatic region. There was an equal distribution of LNs between the cephalic and body-tail portions. The lymphatic vascularization appeared in continuity from the celiac trunk to the distal ends of its hepatic and splenic arterial branches parallel to the nerve ramifications of the celiac plexus. We also observed a continuity between the drainage of the pancreatic head and the para-aortic region posteriorly. CONCLUSION: In view of the wealth of peri-pancreatic LNs, the number of LNs to harvest could be increased to improve nodal staging and prognostic evaluation. Pancreatic anatomy as described does not seem to be compatible with the sentinel LN procedure in pancreatic surgery. Finally, we are now able to offer an alternative to manual alignment with a semi-automated alignment.
Authors: Pablo E Serrano; Sean P Cleary; Neesha Dhani; Peter T W Kim; Paul D Greig; Kenneth Leung; Carol-Anne Moulton; Steven Gallinger; Alice C Wei Journal: Ann Surg Oncol Date: 2014-10-28 Impact factor: 5.344
Authors: T A Sohn; C J Yeo; J L Cameron; L Koniaris; S Kaushal; R A Abrams; P K Sauter; J Coleman; R H Hruban; K D Lillemoe Journal: J Gastrointest Surg Date: 2000 Nov-Dec Impact factor: 3.452