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First jejunal vein, jejunal trunk, and pancreatico-duodenectomy: resolving the literature conundrum

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Abstract

A detailed knowledge of the surgical anatomy of tributaries of the superior mesenteric vein, especially proximal jejunal venous anatomy (first jejunal vein and jejunal trunk), is a key prerequisite for performing a safe pancreatico-duodenectomy. However, the available literature on the anatomical course and surgical relevance of these vessels is scarce, the nomenclature across the articles is heterogeneous, and the resulting evidence is confusing to interpret. Standardized terminology and an in-depth review of these vessels with regard to their course, termination, vascular relations, and variations will help the surgeons in planning and performing this complex surgery safely, especially when a venous resection and reconstruction is planned in cases of borderline resectable pancreatic cancer. A uniform nomenclature and a unifying classification are proposed in this review for these two tributaries to help resolve the literature conundrum. This standardized terminology and anatomical description will assist the radiologists in reporting pancreatic protocol-computed tomography scans and surgeons in selecting the appropriate steps for the different anatomical orientations of these tributaries for the performance of safe pancreatic surgery. This will also help future researchers communicate in well-defined terms in reference to these tributaries so as to avoid confusion in future studies.

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References

  1. Younan G, Tsai S, Evans D, Christians K (2016) Techniques of vascular resection and reconstruction in pancreatic cancer. Surg Clin N Am 96(6):1351–1370. https://doi.org/10.1016/j.suc.2016.07.005

    Article  PubMed  Google Scholar 

  2. Nakamura M, Nakashima H, Tsutsumi K, Matsumoto H, Muta Y, Ueno D et al (2012) First jejunal vein oriented mesenteric excision for pancreatoduodenectomy. J Gastroenterol 48(8):989–995

    Article  PubMed  Google Scholar 

  3. Sanjay P, Takaori K, Govil S, Shrikhande S, Windsor J (2012) ‘Artery-first’ approaches to pancreatoduodenectomy. Br J Surg. 99:1027–1035

    Article  CAS  PubMed  Google Scholar 

  4. Desai G, Pande P (2019) Gastroduodenal artery: single key for many locks. J of Hepato-Biliary-Pancreatic Sci 26(7):281–291

    Article  Google Scholar 

  5. Papavasiliou P, Arrangoiz R, Zhu F, Chun Y, Edwards K, Hoffman J (2012) The anatomic course of the first jejunal branch of the superior mesenteric vein in relation to the superior mesenteric artery. Int J Surg Oncol 2012:1–4

    Google Scholar 

  6. Katz M, Fleming J, Pisters P, Lee J, Evans D (2008) Anatomy of the superior mesenteric vein with special reference to the surgical management of first-order branch involvement at pancreaticoduodenectomy. Annals of Surg 248(6):1098–1102

    Article  Google Scholar 

  7. Kobayashi Y, Sakamoto Y, Arita J, Akamatsu N, Kaneko J, Hasegawa K et al (2017) Vascular anatomy of the jejunal mesentery and complications associated with division of the first jejunal venous trunk during pancreaticoduodenectomy. J Surg Oncol 117(6):1297–1304

    Article  PubMed  Google Scholar 

  8. Hosokawa Y, Nagakawa Y, Sahara Y, Takishita C, Nakajima T, Hijikata Y et al (2018) Surgical outcomes of pancreaticoduodenectomy for pancreatic cancer with proximal dorsal jejunal vein involvement. J Gastrointest Surg 22(7):1179–1185

    Article  PubMed  Google Scholar 

  9. Mourad N, Zhang J, Rath A, Chevrel J (1994) The venous drainage of the pancreas. Surg Radiol Anat 16(1):37–45

    Article  CAS  PubMed  Google Scholar 

  10. Falconer C, Griffiths E (1950) The anatomy of the blood-vessels in the region of the pancreas. Br J Surg 37(147):334–344

    Article  CAS  PubMed  Google Scholar 

  11. Sharma M, Babu CS, Garg S, Rai P (2012) Portal venous system and its tributaries: a radial endosonographic assessment. Endosopic Ultrasound 1(2):96

    Article  CAS  Google Scholar 

  12. Reichardt W, Cameron R (1980) Anatomy of the pancreatic veins. Acta Radiol Diagn 21(1):33–41

    Article  CAS  Google Scholar 

  13. Birtwisle Y, Ferrari C, Bourgeon A, Butori P, Hannoun L, Richelme H (1983) Venous drainage of the pancreas and its relations to pancreatic phlebography. Anatomia Clinica 5(2):103–113

    Article  Google Scholar 

  14. Negoi I, Beuran M, Hostiuc S, Negoi R, Inoue Y (2018) Surgical Anatomy of the superior mesenteric vessels related to pancreaticoduodenectomy: a systematic review and meta-analysis. J Gastrointest Surg 22(5):802–817

    Article  PubMed  Google Scholar 

  15. Peltrini R, Luglio G, Pagano G, Sacco M, Sollazzo V, Bucci L (2019) Gastrocolic trunk of Henle and its variants: review of the literature and clinical relevance in colectomy for right-sided colon cancer. Surg Radiol Anat 41(8):879–887

    Article  PubMed  Google Scholar 

  16. Maki Y, Mizutani M, Morimoto M, Kawai T, Nakagawa M, Ozawa Y et al (2016) The variations of the middle colic vein tributaries: depiction by three-dimensional CT angiography. Br J Radiol 89(1063):20150841

    Article  PubMed  PubMed Central  Google Scholar 

  17. Ishikawa Y, Ban D, Matsumura S, Mitsunori Y, Ochiai T, Kudo A et al (2017) Surgical pitfalls of jejunal vein anatomy in pancreaticoduodenectomy. J Hepatobiliary Pancreat Sci 24(7):394–400

    Article  PubMed  Google Scholar 

  18. Kim H, Ko Y, Lim J, Lee D (2006) Radiologic anatomy of the superior mesenteric vein and branching patterns of the first jejunal trunk: evaluation using multi-detector row CT venography. Surg Radiol Anat 29(1):67–75

    Article  CAS  PubMed  Google Scholar 

  19. Akita M, Maeda E, Nishimura T, Abe K, Kozuki A, Yokoyama K et al (2021) Anatomical change of SMV branches after the Cattell Braasch maneuver facilitates safe resection around the uncinated process in pancreatoduodenectomy. BMC Surg 21(1)

  20. Sakaguchi T, Suzuki S, Morita Y, Oishi K, Suzuki A, Fukumoto K et al (2010) Analysis of anatomic variants of mesenteric veins by 3-dimensional portography using multidetector-row computed tomography. Am J Surg 200(1):15–22

    Article  PubMed  Google Scholar 

  21. Nayak S (2018) Variant termination of first and second jejunal veins into a “pancreatic portal vein”. Surg Radiol Anat 41(3):347–349

    Article  PubMed  Google Scholar 

  22. Nayak S, Mishra S, George B (2017) A strange case of superior mesenteric venous collar around the superior mesenteric artery. Surg Radiol Anat 39(8):931–933

    Article  PubMed  Google Scholar 

  23. Nagakawa Y, Nakagawa N, Takishita C, Uyama I, Kozono S, Osakabe H et al (2021) Reconsideration of the appropriate dissection range based on Japanese anatomical classification for resectable pancreatic head cancer in the era of multimodal treatment. Cancers 13(14):3605

    Article  PubMed  PubMed Central  Google Scholar 

  24. Nagakawa Y, Hosokawa Y, Sahara Y, Takishita C, Hijikata Y, Osakabe H et al (2018) Approaching the superior mesenteric artery from the right side using the proximal-dorsal jejunal vein preisolation method during laparoscopic pancreaticoduodenectomy. Surg Endosc 32(9):4044–4051

    Article  PubMed  Google Scholar 

  25. Nishimura S, Takahashi H, Akita H, Asukai K, Hasegawa S, Yamada D et al (2019) The anatomical pattern of the proximal jejunal vein as a prognostic factor in patients with pancreatic head cancer treated with preoperative chemoradiation therapy. Anticancer Res 39(10):5821–5830

    Article  PubMed  Google Scholar 

  26. Aldouri A, Wang K, Upasani V, Yamaue H (2019) Mapping of the superior mesenteric vessels for artery first pancreatoduodencectomy in patients with high visceral fat. HPB 21:S860

    Article  Google Scholar 

  27. Hamabe A, Park S, Morita S, Tanida T, Tomimaru Y, Imamura H et al (2018) Analysis of the vascular interrelationships among the first jejunal vein, the superior mesenteric artery, and the middle colic artery. Ann Surg Oncol 25(6):1661–1667

    Article  PubMed  Google Scholar 

  28. Vasiliadis K (2021) “Mesopancreas-first” radical resection of pancreatic head cancer following the Cattell–Braasch–Valdoni maneuver: appreciating the legacy of pioneers in visceral surgery. Ann Hepatobiliary Pancreat Surg 25(3):376–385

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kawabata Y, Tanaka T, Nishi T, Monma H, Yano S, Tajima Y (2012) Appraisal of a total meso-pancreatoduodenum excision with pancreaticoduodenectomy for pancreatic head carcinoma. Eur J Surg Oncol 38:574–579

    Article  CAS  PubMed  Google Scholar 

  30. Kang M, Kim S (2020) En bloc proximal peri-mesenteric clearance for pancreatic head cancer surgery. Ann Hepatobiliary Pancreat Surg 24(4):389–395

    Article  PubMed  PubMed Central  Google Scholar 

  31. Brennan D, Zamboni G, Sosna J, Callery M, Vollmer C, Raptopoulos V et al (2007) Virtual whipple: preoperative surgical planning with volume-rendered MDCT images to identify arterial variants relevant to the whipple procedure. AJR Am J Roentgenol 188(5):W451–W455

    Article  PubMed  Google Scholar 

  32. Desai G, Pande P, Shah R, Jagannath P (2018) Pancreaticoduodenectomy with replaced common hepatic artery and portal vein reconstruction in primary carcinoma duodenum: a case report and literature review. J Gastrointest Cancer 50(3):684–688

    Article  Google Scholar 

  33. Zhu C, Ma L, Jia Z, Shi H, Jin J, Lou W et al (2020) Novel morphological classification of the normal pancreatic uncinate process based on computed tomography. Int J Appl Basic Med Res 48(9):030006052095745

    Google Scholar 

  34. Lin P, Chaikof E (2000) Embryology, anatomy, and surgical exposure of the great abdominal vessels. Surg Clin North Am 80:417–433

    Article  CAS  PubMed  Google Scholar 

  35. Delpero J, Sauvanet A (2020) Vascular resection for pancreatic cancer: 2019 French recommendations based on a literature review from 2008 to 6-2019. Front Oncol:10

  36. Garces-Descovich A, Beker K, Jaramillo-Cardoso A, James Moser A, Mortele K (2018) Applicability of current NCCN Guidelines for pancreatic adenocarcinoma resectability: analysis and pitfalls. Abdom Radiol 43(2):314–322

    Article  Google Scholar 

  37. Müller P, Frey M, Ruzza C, Nickel F, Jost C, Gwerder C et al (2020) Neoadjuvant chemotherapy in pancreatic cancer: an appraisal of the current high-level evidence. Pharmacology 1-11

  38. Tseng JF, Raut CP, Lee JE, Pisters PW, Vauthey JN, Abdalla EK et al (2004) Pancreaticoduodenectomy with vascular resection: margin status and survival duration. J Gastrointest Surg 8(8):935–950

    Article  PubMed  Google Scholar 

  39. Yekebas E, Bogoevski D, Cataldegirmen G, Kunze C, Marx A, Vashist Y et al (2008) En bloc vascular resection for locally advanced pancreatic malignancies infiltrating major blood vessels. Ann Surg 247(2):300–309

    Article  PubMed  Google Scholar 

  40. Nappo G, Donisi G, Zerbi A (2021) Borderline resectable pancreatic cancer: certainties and controversies. World J Gastrointest Surg 13(6):516–528

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, 400050, India

    Gunjan Desai & Prasad K. Wagle

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  1. Gunjan Desai
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  2. Prasad K. Wagle
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Contributions

Gunjan Desai: collection of the data, analysis of data, preparation of the initial draft of the manuscript, critical revision of the manuscript for intellectual content, technical support, material support, study supervision. Prasad Wagle: collection of the data, analysis of the data, preparation of the initial draft of the manuscript, critical revision of the manuscript for intellectual content, technical support, material support, study supervision

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Correspondence to Gunjan Desai.

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The study was performed in accordance with international agreements (World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects,” amended in October 2013, www.wma.net).

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Desai, G., Wagle, P.K. First jejunal vein, jejunal trunk, and pancreatico-duodenectomy: resolving the literature conundrum. Langenbecks Arch Surg 408, 104 (2023). https://doi.org/10.1007/s00423-023-02849-w

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