Anatomical Distribution of Para-aortic Lymph Nodes with Relation to Celiac Ganglia and Splanchnic Nerves for the Neural Tissue Preserving-surgery on the D3 Dissection for Advanced Gastric Cancers

Masato Nomura, Masazumi Takahashi, Hirotoshi Akiyama, Yoshihiro Moriwaki, Goro Matsuda, Chikara Kunisaki, Hiroyuki Yamaoka and Hiroshi Shimada

Second Department of Surgery, Yokohama City University, School of Medicine

We studied abdominal aortic lesion anatomy for neural tissue preserving surgery in D3 dissection for advanced gastric cancer. Materials and methods: Paraaortic lesion, i.e., greater and lesser splanchnic nerves, celiac ganglia, and celiac plexus, were examined macroscopically in 31 cadavers. Using transverse sections of 14 cadavers, histology was also conducted focusing on the relationship of lymph nodes, neural tissue, and vessels. Results: The greater and lesser splanchnic nerves run across from both sides and merge into the celiac ganglion, which consists of only 1 ganglion (type I) or several ganglia (type II). Type I was frequently found on both left and right sides. The splanchnic nerve appears in the abdomen more caudal and lateral than that on the left. The average number of lymph nodes was 6.4 in No. 16a2inter, 7.5 in No. 16a2latero, 4.4 in No. 16b1inter, and 5.2 in No. 16b1latero. Lymph nodes of a2 and b1 in the lateral side of the aorta were larger in number than on the internal side. Lymph nodes were detected behind the celiac ganglia and splanchnic nerve in all cases, but not in the layer between arteries and the neural tissue. Conclusion: The nerve system and lymph node distribution around the aorta have several patterns, and anatomical studies, around the aorta provide useful information for effective, safe lymph node dissection.

Key words
celiac ganglia, splanchnic nerve, para-aortic lymph nodes, anatomy

Reprint requests
Masato Nomura 2^nd Dept. of Surgery, Yokohma City University School of Medicine
3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 JAPAN

Accepted
November 26, 2003

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