Splenic flexure drainage pathways indicated by green arrows. (A) Main pathway toward the left colic artery (LCA); (B) main pathway toward the left branch of the middle colic artery (lt-MCA); (C) in patients in whom there exists the left accessory aberrant colic artery (LAACA) 3 routes indicated by the letters a, b and c are identified. The black dotted line indicates the boundaries of the D3 area based on the principles of the Japanese Society for Cancer of the Colon and Rectum.

Contexts in source publication

Context 1

... intraoperative subserosal injection of ICG, Watanabe et al. (36) studied the direction of lymphatic flow from splenic flexure tumors in 31 patients. They recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. ...

Context 2

... recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. Interestingly no case exhibited a lymph flow in both the LCA and lt-MCA areas. ...

Context 3

... recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. Interestingly no case exhibited a lymph flow in both the LCA and lt-MCA areas. ...

Context 4

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...

Context 5

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...

Context 6

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...

Context 7

... intraoperative subserosal injection of ICG, Watanabe et al. (36) studied the direction of lymphatic flow from splenic flexure tumors in 31 patients. They recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. ...

Context 8

... recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. Interestingly no case exhibited a lymph flow in both the LCA and lt-MCA areas. ...

Context 9

... recognized different patterns schematized in Figure 4 according to the presence (in 61% of patients) or absence (in 39% of patients) of the left accessory aberrant colic artery (LAACA) which originates from the superior mesenteric artery more proximally to the middle colic artery, at the inferior border of the pancreas. In patients in whom the LAACA was not present, the prevalent direction of the lymphatic flow was along the LCA ( Figure 4A) in 68% of patients and along the lt-MCA ( Figure 4B) in 31% of cases. Interestingly no case exhibited a lymph flow in both the LCA and lt-MCA areas. ...

Context 10

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...

Context 11

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...

Context 12

... no case exhibited a lymph flow in both the LCA and lt-MCA areas. When the LAACA was present 3 different patterns where observed: along the LAACA (route B in Figure 4C) in 33% of cases, along the LAACA and the lt-MCA (routes A + B in Figure 4C) in 25% of patients, or along the LAACA and the LCA (routes B + C in Figure 4C) in the remaining 42%. Since no systematic data nor clear unequivocal indication exist on the proper extent of lymphadenectomy/site of vascular ligation, in patients with these tumors, understanding the individual lymph flow direction might help deciding the more appropriate operative procedure. ...