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By extrapolating results from two methodologies, the goal is to determine the arterial ligation level and the lymphadenectomy extent for duodenojejunal tumor treatment.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Material and Methods<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>SJA proper was present in 72 cases (74.2%). The mean SJA caliber was 3.4\u2009\u00b1\u20091.2\u00a0mm. SJA originated 17.5\u2009\u00b1\u200916.8\u00a0mm 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\u2009\u00b1\u20090.53\u00a0mm and 0.6\u2009\u00b1\u20090.35\u00a0mm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>\u201cSurgery with Extended (D3) Mesenterectomy for Small Bowel Tumors\u201d registered at <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT05670574\" ext-link-type=\"uri\">https:\/\/classic.clinicaltrials.gov\/ct2\/show\/NCT05670574<\/jats:ext-link> NCT05670574<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00464-025-11909-9","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T13:34:10Z","timestamp":1751895250000},"page":"5421-5429","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Lymphatic and vascular anatomy define surgical principles for radical treatment of distal duodenal\u00a0and proximal jejunal tumors"],"prefix":"10.1007","volume":"39","clinical-trial-number":[{"clinical-trial-number":"nct05670574","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4862-7561","authenticated-orcid":false,"given":"Teodor","family":"Vasic","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Stimec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4488-9812","authenticated-orcid":false,"given":"Bojan Vladimir","family":"Stimec","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3137-6225","authenticated-orcid":false,"given":"Bj\u00f8rn","family":"Edwin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8565-0568","authenticated-orcid":false,"given":"Dejan","family":"Ignjatovic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"11909_CR1","volume-title":"Das LYMPHGEF\u00c4\u00dfSYSTEM DES MENSCHEN","author":"G Jossifow","year":"1930","unstructured":"Jossifow G (1930) Lymphgef\u00e4\u00dfe des d\u00fcnndarms. 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The authors have not received any financial grants or funding for this study and declare no industrial conflicts of interest affiliations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"Patients have signed an informed consent form.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}},{"value":"The clinical trial was ethically approved by the Regional Ethical Committee South-East, Norway (number 19898).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethic approval"}}]}}