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Gynecol Oncol. 2010 Jan;116(1):33-7. doi: 10.1016/j.ygyno.2009.09.003. Epub 2009 Oct 17.

Pelvic lymphadenectomy in cervical cancer--surgical anatomy and proposal for a new classification system.

Author information

1
Oncogynecological Centre, Department of Obstetrics and Gynecology, General Faculty Hospital, First Medical Faculty, Charles University, Apolinarska 18 Prague 2, 12000, Czech Republic. david.cibula@iol.cz

Abstract

BACKGROUND:

Pelvic lymphadenectomy is an integral component of gynecologic cancer surgery, yet there is a lack of standardization in the terminology used, the extent of the procedure, and the definition of anatomic landmarks. This lack of standardization if corrected will likely facilitate a more clear communication and analysis of outcomes from various institutions, and reduce confusion to trainees about the procedure being performed.

METHODS:

We summarize the anatomic data concerning pelvic lymphatic drainage; describe the procedure based on clearly defined anatomic landmarks; and finally propose a new classification system to facilitate standardization, communication, and comparison of results. The accompanying video demonstrates the anatomic landmarks.

RESULTS:

We list and define four commonly used terms related to pelvic lymph node harvesting: sentinel node mapping, excision of bulky nodes, pelvic lymph node sampling, and systematic pelvic lymphadenectomy. We list the five specific anatomic regions of the pelvic lymphatic basin: external iliac, obturator, internal iliac, common iliac, and presacral. We highlight the important neural structures located in regions of the pelvic lymphadenectomy: genitofemoral nerve, obturator nerve, cranial part of the lumbosacral plexus, hypogastric plexus, and splanchnic nerves. Finally, we propose a new, four-part classification system of types of pelvic lymph node dissection.

CONCLUSION:

In this report and video, we demonstrate anatomy and offer a new classification system for pelvic lymphadenectomy.

PMID:
19837449
DOI:
10.1016/j.ygyno.2009.09.003
[Indexed for MEDLINE]

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