J.Jpn. Surg. Soc.. 80(12): 1515-1519, 1979

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Report on the annual meeting

SOME TECHNICAL CONSIDERATIONS ON THE LYMPHNODE DISSECTION IN THE CURATIVE OPERATION FOR THE LARGE BOWEL CANCER

Some technical points of regional lymphnode dissection of the colon, rectum and anal canal, which were the main parts of the operative procedure for cancer surgery, were discussed. It was necessary to consider three lymphatic pathways separately, namely that along superior mesenteric vessels, that along inferior mesenteric vessels and that along internal iliac vessels.
On the anatomical stand point of view, the former two lymphatic ways converge to the origins of correspond vessels and can be controlled easily in surgery, on the other hand the latter one spreads out in several directions and is complex to be taken out completely.
On the clinical point, the dissection of lymphnodes of the colon is more effective for cancer cure than of the rectum and anal canal.
If the short phrases are allowed to explane the principles of dissecting technic on each lymphatic pathways, those should be as follow.
1. Disclosure of surgical trunk of superior mesenteric vein completely, for the lymphnodes along superior mesenteric vessels.
2. Amputation of inferior mesenteric artery at its origin from abdominal aorta, for the lymphnodes along inferior mesenteric vessels.
3. Complete clearance of tissues surrounding internal iliac vessels and contents of para-vesical space, for the lymphnodes along internal iliac vessels.

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