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Pelvic and paraaortic lymphadenectomy in gynecologic cancers

Authors
Jeffrey M Fowler, MD
Floor J Backes, MD
Section Editors
Barbara Goff, MD
Tommaso Falcone, MD, FRCSC, FACOG
Deputy Editor
Sandy J Falk, MD, FACOG

INTRODUCTION

Pelvic and paraaortic lymph node evaluation is a major component of the surgical staging procedure for several gynecologic malignancies, including endometrial and ovarian carcinoma [1]. Cervical cancer is clinically staged, but assessment of pelvic and paraaortic lymph nodes is performed with lymphadenectomy and/or imaging.

The surgical and oncologic goals of the lymph node dissection are to define the extent of disease, and thereby, to guide further treatment. Lymphadenectomy may also have a therapeutic goal in conditions in which removing nodes harboring metastatic disease improves survival [2-5].

The role of the pelvic and paraaortic lymph node dissection for women diagnosed with a gynecologic malignancy has evolved since the 1990s. For each tumor site, there is controversy about the extent of dissection (complete lymphadenectomy versus lymph node sampling) and the anatomic level of dissection that is required (ie, pelvic with or without paraaortic nodes).

Techniques for pelvic and paraaortic lymphadenectomy in gynecologic malignancies are reviewed here. Staging of individual tumor sites are discussed separately. (See "Invasive cervical cancer: Staging and evaluation of lymph nodes" and "Endometrial carcinoma: Pretreatment evaluation, staging, and surgical treatment" and "Cancer of the ovary, fallopian tube, and peritoneum: Staging and initial surgical management".)

ANATOMY

Retroperitoneal space — The retroperitoneal space is a potential space that is accessed via a transperitoneal incision, or directly via an extraperitoneal approach. The kidneys, ureters, bladder, great vessels, lymphatic channels, lymph nodes, nerves, and muscles lie underneath the peritoneum and are enveloped in loose areolar connective tissue. Knowledge of the anatomy of the retroperitoneum and the surgical ability to dissect and develop these potential spaces greatly facilitates radical gynecologic surgery and pelvic and paraaortic lymph node dissection. The pararectal and paravesical pelvic spaces and the retroperitoneum of the lower abdomen are developed by the surgeon in order to define the boundaries of the lymph nodes and facilitate the surgical dissection.

                               

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Literature review current through: Nov 2016. | This topic last updated: Fri May 27 00:00:00 GMT+00:00 2016.
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