Browsing by Author "Vasic, Teodor (59669586300)"

BACKGROUND: The jejunum has a wide lymphatic drainage field, making radical surgery difficult. OBJECTIVE: Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery. DESIGN: Two cohort studies. SETTINGS: The first data set comprised dissections of cadavers at the University of Geneva. The second data set incorporated preoperative 3-dimensional CT vascular reconstructions of patients included in the "Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors"clinical trial. PATIENTS: Eight cadavers were dissected. The 3-dimensional CT data set included 101 patients. MAIN OUTCOME MEASURES: Lymph vessels ran parallel and interlaced with jejunal arteries. Lymphatic clearance was minimal at the jejunal artery's origin, radially spreading thereafter. Jejunal arteries were categorized into 3 groups based on position to the middle colic artery origin on 3-dimensional CT: group A: jejunal artery origins lie cranially and caudally to the middle colic artery; group B: jejunal artery origins lie caudal to the middle colic artery; and group C: jejunal artery origins lie cranial to the middle colic artery. Jejunal veins were classified into 3 groups based on their trajectories to the superior mesenteric artery (dorsally/ventrally/combined). RESULTS: Lymph vessel clearances were 1.5 ± 1.0 mm at jejunal artery origins. Group A was present in 81 cases (80.2%), group B in 13 cases (12.9%), and group C in 7 cases (6.9%). Jejunal artery median was 4. Fifty-seven jejunal veins (56.4%) ran dorsally to the superior mesenteric artery, 16 (15.8%) ran ventrally, and 28 (27.8%) had a combined course. LIMITATIONS: Lymph nodes were not counted during dissection because the main observation was the position of lymph vessels. CONCLUSIONS: Minimal jejunal artery lymphatic clearance implies ligating tumor-feeding vessels at the origin. The intermingled jejunal artery lymphatics imply lymph node dissection along the proximal and distal vessels to the level of the first arcade. Classifying jejunal arteries and veins could simplify the anatomy for surgeons. Copyright © 2025 The Author(s).

Background: There is no consensus on the level of vascular ligation and the extent of lymphadenectomy in the treatment of ileal tumors. This study aims to define lymphovascular bundles of the terminal ileal artery (TIA) and subsequent ileal arteries. It also aims to extrapolate results from two distinct methodologies to define the level of arterial ligation and the dissection area for radical and bowel-sparing surgery. Methods: Analysis of 3D-CT mesenteric vascular reconstructions of 104 operated patients. The second dataset consisted of 5 human cadavers for anatomical dissection. In one case, harvested viscera underwent the superior mesenteric artery (SMA) perfusion after ligation of the TIA. Results: The calibers of the first three ileal arteries were: 2.67 ± 0.98 mm, 2.22 ± 0.78 mm, 2.31 ± 1.24 mm. The distances from the first three ileal arteries to the ileocolic artery (ICA) origin were: 12.45 ± 8.79 mm, 27.45 ± 13.47 mm, and 43.04 ± 16.94 mm. The SMA trifurcated in 61 (59%) of cases and bifurcated in 43 (41%). In 89 cases, the combined ICA + first jejunal artery caliber (6.7 ± 1.6 mm) was greater than the TIA caliber (4.84 ± 1.42 mm). The ileal artery lymphatic clearances were 0.85 mm to the preceding vessel. In the D3 volume at the ICA origin, 3–8 lymph nodes were observed. Internal calibers of the small bowel marginal artery, after selective TIA ligation and the SMA perfusion, were: proximal jejunal part 0.417 mm and distal ileal part 0.291 mm. Conclusions: Ileal tumors are irrigated through the TIA, which can be ligated without consequences. Lymphadenectomy should encompass the adjacent vessels (1st jejunal artery, ICA) and can include the central nodes (D3 volume) at the surgeon’s preference. Preserving the adjacent vessels and the marginal artery is paramount for bowel-sparing surgery. © The Author(s) 2025.