Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2025 Aug;39(8):5421-5429.
doi: 10.1007/s00464-025-11909-9. Epub 2025 Jul 7.

Lymphatic and vascular anatomy define surgical principles for radical treatment of distal duodenal and proximal jejunal tumors

Teodor Vasic  1 , Milena Stimec  2 , Bojan Vladimir Stimec  2 , Bjørn Edwin  3   4 , Dejan Ignjatovic  5   6
Affiliations
Clinical Trial

Lymphatic and vascular anatomy define surgical principles for radical treatment of distal duodenal and proximal jejunal tumors

Teodor Vasic et al. Surg Endosc. 2025 Aug.

Erratum in

Abstract

Background: The arterial ligation level and the lymphadenectomy extent for surgical treatment of distal duodenal/proximal jejunal tumors are not standardized.

Aim: To define morphometric and topographic specifics of the superior jejunal artery (SJA) and the superior jejunal vein (SJV), and the width of arterial lymphovascular bundles through lymphatic clearances. By extrapolating results from two methodologies, the goal is to determine the arterial ligation level and the lymphadenectomy extent for duodenojejunal tumor treatment.

Material and methods: The first series included an analysis of preoperative 3D-CT vascular reconstructions from 97 patients. The second series included 11 dissected cadavers where the course of the proximal mesenteric lymphatics was followed. The SJA was defined as the uppermost jejunal artery (JA) counted from the ileocolic artery (ICA) origin.

Results: SJA proper was present in 72 cases (74.2%). The mean SJA caliber was 3.4 ± 1.2 mm. SJA originated 17.5 ± 16.8 mm cranial to the middle colic artery (MCA) origin and was found cranial to it in 84 cases. SJA originated caudal to the inferior pancreatic border in 80 cases (82.8%) and cranial in 17 (17.2%). SJV coursed anteriorly to the superior mesenteric artery in 29 cases (29.9%). The distances of the cranial and caudal lymphatics following SJA at the level of the arterial origin were 1.15 ± 0.53 mm and 0.6 ± 0.35 mm.

Conclusions: To achieve adequate lymphatic clearance, it is crucial to ligate the tumor-feeding SJA at its origin. The conical arrangement of the SJA lymphatics underscores the necessity of a mesenterectomy extending both cranially and caudally, including lymphadenectomy along the adjacent JA to the level of the first arcade.

Trial registration: "Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors" registered at https://classic.

Clinicaltrials: gov/ct2/show/NCT05670574 NCT05670574.

Keywords: D3 volume; Duodenum; Jejunal artery; Jejunum; Lymphadenectomy; Surgical technique.

PubMed Disclaimer

Conflict of interest statement

Declarations. Conflicts of interest: Dr. Vasic Teodor, Dr. Stimec Milena, Dr. Stimec V Bojan, Professor Dr. Edwin Bjørn, and Professor Dr. Ignjatovic Dejan report no conflicts of interest. The authors have not received any financial grants or funding for this study and declare no industrial conflicts of interest affiliations. Consent to participate: Patients have signed an informed consent form. Consent to publication: Not applicable. Ethic approval: The clinical trial was ethically approved by the Regional Ethical Committee South-East, Norway (number 19898).

Figures

Fig. 1
Fig. 1
Anatomical dissection of the superior jejunal artery’s lymphovascular bundle. ICA Ileocolic artery; MCA middle colic artery; JAs jejunal arteries; DJJ duodenojejunal junction; SJA superior jejunal artery; green*SJA,→collector lymph vessel along the SMA left-hand side,←→SJA’s lymphatic clearance
Fig. 2
Fig. 2
Three-dimensional SMA/SMV reconstructions and illustrations of the spatial relationship between the superior jejunal artery and the superior jejunal vein. On the left, the posterior SJV course, on the right, the anterior SJV course (pseudo-bifid SMV); SMA superior mesenteric artery; SMV superior mesenteric vein; ICA ileocolic artery; MCA middle colic artery; GTH gastrocolic trunk of Henle; ICV ileocolic vein; JA jejunal artery (i.e., 2nd JA); SJA superior jejunal artery; SJV superior jejunal vein; JV jejunal vein; IMV inferior mesenteric vein; SV splenic vein
Fig. 3
Fig. 3
The proposed technique of the D2 and D3 mesenterectomy in radical small bowel resection for the distal duodenal and jejunal tumors. On the left, blue area: D2 mesenterectomy; on the right, green area bordered with dashed line: extended D3 mesenterectomy, blue area: D2 mesenterectomy; SJA superior jejunal artery; JA jejunal artery; LNs lymph nodes; SMA/SMV superior mesenteric artery/vein; MCA middle colic artery; GTH the gastrocolic trunk of Henle; Tu tumor
See this image and copyright information in PMC

References

    1. Jossifow G (1930) Lymphgefäße des dünndarms. In: Jossifow G (ed) Das LYMPHGEFÄßSYSTEM DES MENSCHEN. Gustav Fischer, Jena
    1. Jossifow G (1930) Lymphgefäße des dünndarms. In: Jossifow G (ed) Das lymphgefässsystem des menschen. Gustav Fischer, Jena
    1. Rosse C, RosseGaddum P, Hollinshead H (1997) The gut and its derivates. Hollinshead’s textbook of anatomy, 5th edn. Lippincott-Raven Publishers, Philadelphia, pp 578–579
    1. Benson AB, Venook AP, Al-Hawary MM, Arain MA, Chen YJ, Ciombor KK, Cohen SA, Cooper HS, Deming DA, Garrido-Laguna I, Grem JL, Hoffe SE, Hubbard J, Hunt S, Kamel A, Kirilcuk N, Krishnamurthi S, Messersmith WA, Meyerhardt J, Miller ED, Mulcahy MF, Steven Nurkin Md, Ms OMJ, Parikh A, Patel H, Pedersen KS, Saltz LB, Schneider C, Shibata D, Skibber JM, Sofocleous CT, Stoffel EM, Stotsky-Himelfarb E, Willett CG, Johnson-Chilla A, Gregory KM, Gurski LA (2019) Small bowel adenocarcinoma, version 1.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 17:1109–1133 - PMC - PubMed
    1. Lamarca A, Bartsch DK, Caplin M, Kos-Kudla B, Kjaer A, Partelli S, Rinke A, Janson ET, Thirlwell C, van Velthuysen MLF, Vullierme MP, Pavel M (2024) European Neuroendocrine Tumor Society (ENETS) 2024 guidance paper for the management of well-differentiated small intestine neuroendocrine tumours. J Neuroendocrinol. 10.1111/jne.13423 - PubMed

Publication types

MeSH terms

Associated data