Device for Cleaning Tissue Around the Superior Mesenteric Artery, from the Yiewpoint of the Mode of Invasion in Pancreatic Head Cancer

Akihiro Kawabata, Takashi Suzuki

Department of Surgery II, Yamaguchi University School of Medicine

This study was performed to examine to what extent the regional lymph nodes around the superior mesenteric artery (SMA) can be dissected while preserving the superior mesenteric nerve plexus (PLsma) in radical surgery for periampullary cancer. The distance from the adventitia of the SMA to the lymph node was 5.5±2.0 mm. Only nine of 142 slices (6.3%) were located within 3 mm from the adventitia. In both the region between the dorsal wall of the SMA root and the aorta, and between the SMA and arteries branching off the SMA, lymph nodes were found within the nerve plexus. Since most of the lymph nodes were located outside the PLsma, it was suggested that the dissection of lymph nodes around the SMA while preserving the PLsma should be feasible. In 25 cases of ductal adenocarcinoma of the pancreatic head we found many small metastatic lymph nodes whose diameter was less than 5 mm. There were two types of tumors, predominantly lymphatic invasion or neural invasion, which suggested that lymphatic invasion and neural invasion have different pathway. We found nerve plexus invasion in72.2% of invasive ductal adenocarcinomas invading the posterior region of the head, while there was no neural invasion in the cases of mucinous cystadenocarcinoma and so called mucus producing pancreatic cancer.

Key words
pancreatic cancer, lymph node involvement, superior mesenteric nerve plexus

Reprint requests
Akihiro Kawabata Department of Surgery II, Yamaguchi University School of Medicine
1144 Kogushi, Ube, 755 JAPAN

Accepted
July 6, 1994

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