An anatomic study of the peripancreatic lymphatics.

A detailed study of the lymphatics around the pancreas was carried out in order to provide a theoretic basis for ideal lymph-node resection in radical cancer operations. The following results were obtained as a result of minute macroscopic dissection of the lymphatics. Three major pathways are identified on the anterior surface of the head of the pancreas. The upper pathway belongs to the common hepatic group. The middle and lower routes are associated with the superior mesenteric nodal group. All these pathways terminate in the node situated to the right of the origins of the celiac trunk and the superior mesenteric artery. The lymphatics arising from the neck of the pancreas also converge at the same node. Behind this node, there is a terminal node for the lymphatics which arise from the posterior surface of the head. Both nodes are firmly adherent, with only the nerve plexus of the head of the pancreas intervening. In this study, we have named these lymph-nodes Lnn celiacomesenterici dextri superficialis et profundi. Two distinct pathways are identified in the left half of the pancreas. One follows the splenic blood vessels and the other accompanies the inferior pancreatic artery. By way of these routes, lymphatics from the left half of the pancreas terminate in the node situated to the left of the origins of the celiac trunk and superior mesenteric artery. We have applied the term Ln celiacomesentericus sinister to this node. From these lymphatic terminalis on both sides of the origins of the two arteries, efferent vessels are sent to the abdomino-aortic nodes: on the right side, efferents reach the inter-aorticovenous nodes lying in the upper and lower angles formed by the inferior vena cava and the left renal vein; and on the left side, they arrive at the left latero-aortic nodes lying above and below the left renal vein. The efferents of these nodes then extend to the retro-aortic space, where they compose an ascending lymphatic system. Our study revealed no lymphatic vessels communicating with the retro-aortic system at levels above the renal arteries.