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Lymph nodes are bean-shaped structures that cluster along the lymphatic vessels in the inguinal, axillary, and cervical regions. Each node is divided into compartments by a capsule that extends trabeculae inward.
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Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study.

Dhiresh Kumar Maharjan1, Prashanta Pudasaini1, Bidur Prasad Acharya1

  • 1Department of Gastrointestinal and General Surgery, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal.

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Summary
This summary is machine-generated.

The TRIANGLE operation, crucial for pancreaticoduodenectomy, benefits from apical tissue dissection. This ensures complete tumor removal (R0 resection) and improves lymph node yield in the pancreatic head region.

Keywords:
Triangle operationWhipple's operationapical tissue

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Area of Science:

  • Surgical Oncology
  • Gastrointestinal Surgery
  • Pancreatic Surgery

Background:

  • The TRIANGLE operation involves en-bloc removal of the tumor and mesopancreas within a specific anatomical space.
  • Accurate lymph node assessment is critical for staging and treatment planning in pancreatic cancer surgery.

Purpose of the Study:

  • To assess the lymph node yield specifically from the apical tissue during the TRIANGLE operation.
  • To evaluate the impact of apical tissue dissection on achieving complete tumor resection (R0).

Main Methods:

  • An observational cross-sectional study was conducted over two years.
  • 56 patients undergoing pancreaticoduodenectomy with the TRIANGLE operation were included.
  • Lymph node yield from apical tissue and overall specimen was analyzed.

Main Results:

  • The mean total lymph node yield was 20.95±8.57.
  • The mean lymph node yield from the triangle tissue was 10.59±4.92, with 2.58±1.64 positive nodes.
  • 37 out of 56 patients achieved negative margins for both apical tissue and the rest of the triangle circumferential resection.

Conclusions:

  • Dissection of apical tissue at the SMA and coeliac trunk confluence is vital for achieving R0 resection.
  • Further long-term follow-up is needed to fully assess the impact of this technique.