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Investigation of the variation of vessels around the pancreatic head based on the first jejunal vein anatomy at pancreaticoduodenectomy

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Abstract

Purpose

Pancreaticoduodenectomy (PD) for pancreatic cancer carries a high risk of massive intraoperative blood loss. The artery first approach (AFA) prevents blood loss during PD, but the optimal approach is unclear. The first jejunal vein (FJV) often comprises multiple veins and broadly supports venous drainage of the proximal jejunum. Its ligation carries a risk of proximal jejunum congestion. Here we investigated the anatomical characteristics of PD-associated vessels and AFA approach selection based on FJV anatomy.

Methods

This study included 148 Japanese living donors for liver transplantation. We reviewed their computed tomography images and assessed the anatomical pattern of PD-associated vessels in terms of FJV anatomy.

Results

The FJV traveled posterior to the superior mesenteric artery in 128 patients (86.5%, dorsal group) and anterior in 20 (13.5%, ventral group). The predominant draining vein of the inferior pancreaticoduodenal vein was the superior mesenteric vein in the ventral group (87.5%) and the FJV in the dorsal group (97.9%). Compared with the dorsal group, the ventral group had a significantly greater percentage with the superior mesenteric vein ventral to the superior mesenteric artery (30.0% versus 10.9%) and a significantly larger posterior superior pancreaticoduodenal vein diameter (3.2 ± 0.9 versus 2.7 ± 0.6 mm, p = 0.0029). These results were validated in patients with pancreatic head cancer.

Conclusions

The anatomical characteristics of PD-associated vessels differed significantly between groups defined by FJV anatomy. Understanding the venous anatomy, especially the FJV, could support selection of the best approach in AFA for PD.

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Data Availability

The data used in this study are available from the corresponding authors on reasonable request.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Keisuke Toya, Yoshito Tomimaru, Shogo Kobayashi, Kazuki Sasaki, Yoshifumi Iwagami, Daisaku Yamada, Takehiro Noda, Hidenori Takahashi, Yuichiro Doki & Hidetoshi Eguchi

Authors
  1. Keisuke Toya
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  2. Yoshito Tomimaru
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  3. Shogo Kobayashi
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  4. Kazuki Sasaki
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  5. Yoshifumi Iwagami
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  6. Daisaku Yamada
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  7. Takehiro Noda
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  8. Hidenori Takahashi
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  9. Yuichiro Doki
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  10. Hidetoshi Eguchi
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Contributions

Study conception and design: Keisuke Toya, Yoshito Tomimaru, Hidenori Takahashi, and Shogo Kobayashi. Acquisition of data: Keisuke Toya, Kazuki Sasaki, and Daisaku Yamada. Analysis and interpretation of data: Keisuke Toya, Yoshito Tomimaru, Yoshifumi Iwagami, and Takehiro Noda. Drafting of manuscript: Keisuke Toya, Yoshito Tomimaru, Shogo Kobayashi, and Hidenori Takahashi. Critical revision of manuscript: Yuichiro Doki and Hidetoshi Eguchi

Corresponding author

Correspondence to Shogo Kobayashi.

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Disclosure

This study had a retrospective design and was approved by the Institutional Ethics Review Committee (Certificate Number 08226). After an extensive dialogue with the Institutional Ethics Review Committee, patient consent for participation was obtained through an opt-out method.

Competing interests and Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

The authors have no conflicts of interest directly relevant to the content of this article.

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Supplementary Information

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Supplemental Fig 1

The anterior and medial uncinate approaches applied in our institution for an artery first approach during pancreaticoduodenectomy (PNG 2.16 MB)

High resolution image (TIFF 26372 KB)

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Toya, K., Tomimaru, Y., Kobayashi, S. et al. Investigation of the variation of vessels around the pancreatic head based on the first jejunal vein anatomy at pancreaticoduodenectomy. Langenbecks Arch Surg 408, 340 (2023). https://doi.org/10.1007/s00423-023-03056-3

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