Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors

Abstract

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).