Superior Mesenteric Artery Group Research Articles

The Medial Border of Laparoscopic D3 Lymphadenectomy for Right Colon Cancer: Results from an Exploratory Pilot Study.

Opinions vary on the medial border of D3 lymphadenectomy for right colon cancer. Most surgeons place the medial border along the left side of the superior mesenteric vein, but some consider the left side of the superior mesenteric artery as the medial border. This study investigated the clinical outcomes of laparoscopic D3 lymphadenectomy for right colon cancer with the medial border along the left side of superior mesenteric artery. This was a retrospective study. The study was conducted in specialized colorectal cancer department of 5 tertiary hospitals. Patients receiving laparoscopic D3 lymphadenectomy for right colon cancer from January 2013 to December 2018 were included. After propensity score matching, 307 patients receiving laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery were assigned to the superior mesenteric artery group and 614 patients were assigned to the superior mesenteric vein group. Univariate, multivariate, and Kaplan-Meier analyses were performed to assess the clinical data. The short-term outcomes were similar between the 2 groups; however, the superior mesenteric artery group had a higher rate of chylous leakage (p < 0.001). More lymph nodes were harvested from the superior mesenteric artery group than from the superior mesenteric vein group (p = 0.001). The number (p = 0.005) of metastatic lymph nodes and the lymph node ratio (p = 0.041) in main nodes were both higher in the superior mesenteric artery group. The 2 groups had similar long-term survival, but the superior mesenteric artery group tended to show better disease-free survival in patients with stage disease III (p = 0.056). This was a retrospective, nonrandomized study. Laparoscopic D3 lymphadenectomy along the left side of the superior mesenteric artery, except for a higher rate of chylous leakage, had short-term outcomes comparable to the superior mesenteric vein group. The superior mesenteric artery group tended to achieve better disease-free survival in patients with stage III disease, but further study is required to better elucidate differences in these approaches because risks/benefits do exist.

Morphogenesis of the ventral pancreas anlagen is influenced by the SMA branching pattern

Developmentally, the uncinate process of the pancreas is derived from the ventral pancreatic anlagen, supplied by the superior mesenteric artery (SMA), and contains pancreatic polypeptide (PP)-rich islets of Langerhans. In contrast, the other parts of the pancreas originate from the dorsal anlagen supplied by the celiac system and contain PP-poor islets. This study was performed to investigate whether morphogenesis of the ventral pancreas anlagen is associated with the pattern of SMA branching. SMA branches to the pancreatic body were dissected in 44 cadavers. The cadavers were divided into two groups: the SMA group in which the SMA gave off branches to the pancreatic body and the General group in which it did not. In the SMA group, the ratio of the diameter of the SMA branch supplying the pancreatic body (SMA branch) to that of the SMA itself was calculated. After dissection was completed, tissues were collected from all pancreatic specimens for HE staining and for immunohistochemistry with PP and insulin antibodies. There were 25 cadavers in the General group and 19 in the SMA group. In 10/19 cadavers from the SMA group, PP-rich islets were confirmed in the pancreatic body. The SMA branch diameter ratio was significantly smaller in the SMA group cadavers with PP-poor islets (n = 9) than in cadavers with PP-rich islets (n = 10) (P < 0.001). These findings suggest a relation between the SMA branching pattern and the distribution of PP cells.

“Caudal-to-cranial” plus “artery first” technique with beyond D3 lymph node dissection on the right midline of the superior mesenteric artery for the treatment of right colon cancer: is it more in line with the principle of oncology?

To explore the feasibility and application value of a "caudal-to-cranial" plus "artery first" technique with beyond D3 lymph node dissection on the right midline of the superior mesenteric artery (SMA) for the treatment of right colon cancer METHODS: Clinical data consisting of 168 right colon cancer cases under going laparoscopic D3 radical resection, including 84 cases of "caudal-to-cranial" plus "artery first" technique with beyond D3 lymph node dissection on the right midline of the SMA (CC + SMA group) and 84 cases of conventional medial approach plus dissection around the superior mesenteric vein (MA + SMV group), from January 2017 to March 2018 were retrospectively analyzed. For CC + SMA group, our surgical method was to isolate the mesocolon using a caudal-to-cranial pathway and ligate blood vessels along the midline of the SMA. The baseline data was not significantly different between the two groups (all p > 0.05). The mean operation time and intraoperative blood loss in the CC + SMA and the MA + SMV groups were 170.04 ± 43.10 versus 172.33 ± 41.84min and 91.07 ± 55.12 versus 77.38 ± 40.21ml, respectively, which has no significant difference (p > 0.05). The mean number of total and positive harvested lymph nodes in the two groups were 29.44 ± 5.90 versus 26.21 ± 6.64 (p < 0.05) and 2.57 ± 1.93 versus 2.51 ± 1.05, respectively (p > 0.05). Compared with the MA + SMV group, there was no significant difference in total postoperative complication rate in the CC + SMA group. The time to pull out drainage tube in the CC + SMA group was longer than MA + SMV group (4.05 ± 1.79 versus 3.38 ± 1.99day; p = 0.022). It is safe and feasible for the "caudal-to-cranial" plus "artery first" technique with beyond D3 lymph node dissection on the right midline of the SMA in right colon cancer. It may have some advantages in the number of lymph nodes dissection, and the long-term prognosis remains to be expected.

Postoperative arterial hemorrhage after pancreatoduodenectomy: Report of five cases

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

Intermittent negative pressure external drainage of the pancreatic duct reduces pancreatic fistula after pancreaticojejunostomy in the patients with soft pancreas

s / Pancreatology 13 (2013) S1–S80 S67 retrospectively analyzed our cases to clarify the effectiveness and limitations on our treatment for the intra-abdominal arterial hemorrhage after PD. Methods: Between March 2000 and April 2013, five of 254 patients (2.0%) developed intra-abdominal hemorrhage in perioperative period after PD. All patients were managed by transcatheter arterial embolization (TAE). The patients can be divided into two groups according to the site of bleeding. Namely, Hepatic Artery (HA) group (4 patients); stump of GDA, RHA and CHA (2patients), and Superior Mesenteric Artery (SMA) group; (1 patient), a branch of jejunal artery of elevated-jejunum for hepaticojejunostomy. Results: All patients had complete hemostasis by single TAE. There was no mortality. The onset of bleeding was on 8th to 14th (median 12th) post-operative day (POD). In 2 of 5 patients, massive bleeding was preceded by minor bleeding 6 to 7 days before. In HA group, 3 patients had past history of upper abdominal surgery (gasterectomy:2, partial resection of duodenectomy:1). In HA group, coil embolization of CHA was performed in all patients. No patients had arterial variation. After embolization the elevation of s-AST/ALT were slight (AST:32-194, ALT:36233) and no hepatic failure was occurred. But liver abscesses were detected in 2 patients 36 and 146 days after embolization. In SMA group the embolization was performed with gelatin, and no complication was observed. The period of hospital stay after TAE was 36 to 146 (median 56) days. Conclusions: Interventional radiology for the arterial hemorrhage after PD was done successfully. A past-history of upper abdominal surgery may be a risk factor of arterial bleeding after PD. In the HA group, it could be useful to employ a metallic covered stent to keep hepatic arterial blood flow and avoid liver abscess formation.

Comparative analysis of celiac versus mesenteric artery outcomes after angioplasty and stenting

Open bypass is the gold standard for treatment of mesenteric ischemia. With the refinement of endovascular therapy, visceral stenting is an attractive minimally invasive alternative, but the data are limited and which vessel responds best to stenting has not been addressed. This study compares the outcomes of superior mesenteric artery (SMA) and celiac artery (CA) stenting. All consecutive patients who underwent visceral stenting between January 2002 and May 2009 were reviewed. Standard statistical analyses, including Kaplan-Meier tests, were performed. Primary patency was defined as peak systolic velocities <350 cm/s for CAs and <450 cm/s for SMAs. Clinical patency was maintenance of either primary patency or the absence of recurrent symptoms. At arteriography, stenosis ≥70% was considered a loss of primary patency. One hundred twenty-one patients received 140 visceral stents in the SMA (n = 92; 65.7%), the CA (n = 40; 28.6%), and the inferior mesenteric artery (n = 8; 5.7%). Twenty-nine stents were placed in men (20.7%) and 111 stents were placed in women (79.3%) with a mean age of 72.9 years (range, 20.5-93.9). The combined SMA/CA stent mean follow-up was 12.8 months. Technical success was 100% for all. Overall 30-day morbidity and mortality rates were 14% and 0.8%, respectively. One-year primary patency was significantly higher for SMA than for CA stents: 55% versus 18%, respectively (P < .0001). Six-month clinical patency was 86% for the SMA and 67% for the CA (P < .005). Loss of CA primary patency was associated with stent diameter <6 mm (P = .042) and age <50 years (two patients; P = .038). These factors did not correlate with loss of primary patency for SMA. Overall freedom from bypass was 93% at 4 years. Visceral stenting has an exceptionally high technical success rate with low procedural morbidity and mortality. Clinical primary patency and primary patency were significantly higher for the SMA group than for the CA group. Our data suggest that CA atherosclerotic lesions do not respond well to endovascular stenting, bringing into question its clinical utility.

Edaravone prevents bowel infarction after acute superior mesenteric artery thromboembolism using autologous fibrin clots in a rabbit model

The aim of this study was to evaluate the effects of intra-arterial administration of edaravone after superior mesenteric artery (SMA) thromboembolism in a rabbit model. 24 Japanese white rabbits were randomly allocated to a urokinase group (group U) and a urokinase with edaravone group (group E). A further three rabbits, which were administered an autologous blood clot alone, served as a control group (group C). A 4-Fr sheath was inserted into an SMA. An autologous blood clot was administered to an SMA (group C). After 45 min, urokinase (6000 IU) and heparin (250 IU) were administered through the catheter, either alone (group U) or in conjuction with edaravone (0.5 mg kg(-1)) (group E). In eight rabbits from each of groups U and E, 6 h after reperfusion, the small intestine was harvested and divided into five equal parts. The degree of intestinal tissue injury in each part was rated on a scale of 0-8. After 1 week, survival times and blood biochemistry data were compared among rabbits in group U (four rabbits), group E (four rabbits) and group C (three rabbits), and significant differences (p<0.05) were recorded. Intestinal mucosal damage was significantly greater in group U (5.8 +/- 1.5) than in group E (2.9 +/- 0.7). Survival time tended to be longer in group E (p>0.4, not significant compared with group U). Liver and kidney function showed signs of deterioration over time whether or not edaravone was administered, but administration of edaravone reduced intestinal mucosal damage. An increase in survival rate requires improvements in evaluation methods to enable identification of ischaemic areas.

Ischemia-modified albumin in the diagnosis of acute mesenteric ischemia: a preliminary study

Ischemia-modified albumin (IMA) is a sensitive marker of myocardial ischemia, skeletal muscle ischemia, pulmonary embolism, and stroke. However, there are no studies showing whether IMA increases in mesenteric ischemia. The aim of this study was to determine whether IMA was elevated in acute mesenteric ischemia. This case-controlled study was performed in an emergency department of a university hospital. The measurement of IMA levels in patient plasma yielded means of 0.264 ± 0.057 absorbance units (ABSU) in the thromboembolic occlusion of the superior mesenteric artery (SMA) group and 0.163 ± 0.025 ABSU in the control group. When plasma IMA levels in the thromboembolic occlusion SMA group were compared with those in the control group, statistically significant increases in IMA were observed in the occlusion group ( P = .003). Findings indicating that IMA may have a place in the diagnosis of acute mesenteric embolism were obtained in this preliminary study. Further prospective studies are needed to see if IMA is clinically useful in the early detection of thromboembolic occlusion of the SMA.

Efficacy of continuous infusion of prostaglandin E1 through the superior mesenteric artery against ischemic liver cell necrosis after hepatic artery occlusion

Hepatic artery occlusion (HAO) can cause severe ischemic liver injury, especially after an interruption of collateral circulation after extensive hepatobiliary surgery. To minimize a decrease in oxygen delivery after HAO, a continuous infusion of prostaglandin (PG)E1 through the superior mesenteric artery (SMA) was studied in comparison with other infusion routes. Twenty-four pigs were assigned to four groups: HAO without PGE1 (control group); HAO with PGE1 (0.02 microg/kg/min, continuously) through the jugular vein (intravenous group); HAO with PGE1 through the portal vein (PV group); and HAO with PGE1 through the SMA (SMA group). PV flow, hepatic oxygen delivery, and serum aspartate aminotransferase were measured after infusion. In addition, 72-hr survival rates were observed, and histologic examination of liver specimens was performed. PGE1 infusion through the SMA seems to affect PV flow and elevate the oxygen content of portal blood, whereas other routes of administration do not. The reduction of hepatic oxygen delivery after HAO was 51% in the control group, 46% in the intravenous group, and 49% in the PV group, whereas it was limited to 13% in the SMA group. Serum aspartate aminotransferase values 24 hr after HAO were lowest in the SMA group, which was statistically significant, as confirmed by histology. The survival rate of animals was 100% in the SMA group and 33% in the other three groups. These findings indicate that continuous PGE1 infusion through the SMA may prove useful in clinical settings to prevent liver damage after HAO.

CT during arterial portography: comparison of injection into the splenic versus superior mesenteric artery.

To determine whether the diagnostic quality of computed tomography (CT) during arterial portography (CTAP) performed via the splenic artery (SA) is better than that performed via the superior mesenteric artery (SMA). The authors evaluated CTAP images obtained in 98 patients from 1991 to 1994; 47 examinations were performed via the SA and 51 were performed via the SMA. Images were reviewed, by consensus, by three radiologists blinded to catheter location. Hepatic enhancement was quantitatively assessed in 53 patients (31 in the SA group, 22 in the SMA group). The numbers of low-attenuation non-tumor-related perfusion defects (19 in the SA group, 17 in the SMA group), high-attenuation non-tumor-related perfusion defects (six in the SA group, six in the SMA group), diffuse mottled perfusion abnormalities (six in the SA group, five in the SMA group), and portal venous flow defects (20 in the SA group, 20 in the SMA group) were similar in both groups (P > .05). Peak hepatic enhancement was similar in both groups (SMA group = 111 HU; SA group = 112 HU) (P > .05). There is no difference in quality between CTAP performed via the SA versus CTAP performed via the SMA.

Lipid peroxidation contributes to cardiac deficits after ischemia and reperfusion of the small bowel.

Our previous studies showed that intestinal ischemia-reperfusion (IR) impairs cardiac contractile function. The present study examined the contribution of oxygen free radicals and lipid peroxidation of cardiac cell membrane to cardiac dysfunction after intestinal IR in a rat model of superior mesenteric artery (SMA) occlusion (atraumatic clip for 20 min) and collateral arcade ligation. Controls were sham operated (group 1, n = 25). In group 2, 30 rats with SMA occlusion were killed 3-4 h after reperfusion without treatment. Aminosteroid (U-74389F), a pharmacological agent known to inhibit lipid peroxidation of membranes, was given 1 min before occlusion of the SMA (group 3, n = 19). All rats were killed 3-4 h after reperfusion of the ischemic intestine, and the hearts were harvested for in vitro assessment of cardiac function (Langendorff preparation). Cardiac contractile depression occurred in the untreated group as indicated by a fall in left ventricular pressure (from 76 +/- 3 to 64 +/- 3 mmHg, P = 0.01), maximum +dP/dt (from 1,830 +/- 60 to 1,577 +/- 64 mmHg/s, P = 0.05), and maximum -dP/dt (from 1,260 +/- 50 to 950 +/- 60 mmHg/s, P = 0.005). Lipid peroxidation of cardiac membranes occurred after untreated IR as indicated by the rise in cardiac malondialdehyde levels (MDA) (from 0.203 +/- 0.046 to 0.501 +/- 0.044 nM/mg protein, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Control of Bleeding Varices by Vasopressin

From July 1975 to November 1976 25 patients with bleeding esophagogastric varices documented by endoscopy who failed to respond to conservative medical treatment were transferred to the Surgical Service. These patients, who were mainly Child's Class "C" alcoholic cirrhotic patients, were treated with vasopressin infused continuously using a standardized dose into either a peripheral vein or the superior mesenteric artery (SMA) according to a predetermined randomization. No significant difference in efficacy for control of bleeding (average rate = 56%) related to route of administration was found. Because catheter-related complications in the SMA group were significantly greater, we concluded that the method of choice in vasopressin treatment of esophagogastric variceal bleeding is a continuous infusion by way of a peripheral vein.