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

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


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.

MeSH terms

  • Female
  • Humans
  • Lymph Node Excision / classification
  • Lymph Node Excision / methods*
  • Lymph Node Excision / standards
  • Lymph Nodes / anatomy & histology
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery*
  • Pelvis / anatomy & histology
  • Pelvis / surgery
  • Terminology as Topic
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery*