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Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery

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Abstract

Objectives

To specify the topography and variations in lymphatic drainage of the right lung to the mediastinum and their therapeutic implications in non-small cell lung cancers (NSCLC).

Materials and method

We injected a dye into the subpleural lymphatic vessels in 65 right lung segments, followed by dissection in 22 subjects.

Results

At the upper lobe, we had injected 32 segments. We noted extrasegmental overflow in one case; extrasegmental and extralobar drainage in two cases; drainage to the lymph nodes of another lobe in one case. Fifty-six percent of the segments drained directly (skipping intrapulmonary and hilar lymph nodes) into the right paratracheal lymph nodes, and one dorsal segment drained into the thoracic duct. A ventral segment drained into the inferior tracheobronchial lymph nodes. A contralateral drainage to the recurrent chain was observed in two cases. Sixteen segments of the middle lobe were injected and mainly drained into the inferior tracheobronchial lymph nodes with six direct paths; one medial segment drained into the right anterior mediastinal chain. We noted three contralateral drainages and eight downward abdominal drainages. Out of the 17 segments of the lower lobe injected, 6 segments drained into the lymph nodes of another lobe, 5 segments showed a direct route to the lower quadrant chains. We noted one time a drainage into the paraesophageal lymph nodes.

Conclusion

The variations in lymphatic drainage of the right lung require to carry out systematically a radical mediastinal lymphadenectomy during the removal of non-small cell lung cancers and to associate an adjuvant treatment.

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Acknowledgments

We thank Messrs Joel prosperi and Sylvain Tyran of the Anatomy Laboratory- Faculty of Medicine- Timone University- Marseille- France for their technical assistance and helpful comments.

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Authors and Affiliations

  1. Department of Anatomy, Health Sciences Unit - Assane Seck University, Ziguinchor, Senegal

    Assane Ndiaye

  2. Clinic of Thoracic and Cardiovascular Surgery, Fann University Hospital Center, BP 16659, Dakar-Fann, Senegal

    Assane Ndiaye, P. S. Ba & M. Gaye

  3. Anatomy Laboratory, Faculty of Medicine Timone, Aix- Marseille University, Marseille, France

    V. Di-marino & S. Nazarian

  4. Anatomy and Organogenesis Laboratory, Faculty of Medicine, CADiop University, Dakar, Senegal

    Aï Ndiaye & M. Gaye

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  1. Assane Ndiaye
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  2. V. Di-marino
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  3. P. S. Ba
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  4. Aï Ndiaye
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  5. M. Gaye
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Correspondence to Assane Ndiaye.

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Ndiaye, A., Di-marino, V., Ba, P.S. et al. Anatomical variations in lymphatic drainage of the right lung: applications in lung cancer surgery. Surg Radiol Anat 38, 1143–1151 (2016). https://doi.org/10.1007/s00276-016-1685-y

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  • DOI: https://doi.org/10.1007/s00276-016-1685-y

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