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Surgical Anatomy of Pelvic Lymph Nodes

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Abstract

The spread of pelvic tumors to loco-regional lymph nodes is an important means of tumor dissemination. Nodal metastases have therapeutic implications for prognosis and management. Pelvic tumors usually metastasize first to regional lymph nodes, which are specific groups of nodes for each type of tumor, and are classified according to the TNM system as N-stage disease (TNM classification of malignant tumors, Oxford, 2009). If a pelvic tumor metastasize to a lymph node outside of the defined regional nodes, this is considered M-stage disease, which may in turn affect the patient’s treatment options and prognosis. Thus, exact knowledge of the regional pelvic lymph node spread of each tumor located within the small pelvis is essential for diagnostic purposes, surgical treatment options, tumor staging and follow-up strategies. A key element in assessing each patient is the correct and precise anatomical description of pelvic nodal metastases to facilitate proper staging and treatment. In the present overview pelvic lymph node anatomy and nomenclature are reviewed with schematic illustrations.

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References

  1. Sobin L, Gospodarowicz M, Wittekind C, editors. TNM classification of malignant tumors. 7th ed. Oxford: Wiley-Blackwell; 2009.

    Google Scholar 

  2. Baluk P, Fuxe J, Hashizume H, et al. Functionally specialized junctions between endothelial cells of lymphatic vessels. J Exp Med. 2007;204:2349–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Gerli R, Ibba L, Fruschelli C. A fibrillar elastic apparatus around human lymph capillaries. Anat Embryol (Berl). 1990;181:281–6.

    Article  CAS  Google Scholar 

  4. Zawieja D. Lymphatic biology and the microcirculation: past, present and future. Microcirculation. 2005;12:141–50.

    Article  CAS  PubMed  Google Scholar 

  5. Weiss L, Schmid-Schonbein GW. Biomechanical interactions of cancer cells with the microvasculature during metastasis. Cell Biophys. 1989;14:187–215.

    Article  CAS  PubMed  Google Scholar 

  6. Cueni LN, Detmar M. The lymphatic system in health and disease. Lymphat Res Biol. 2008;6:109–22.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Brown P. Lymphatic system: unlocking the drains. Nature. 2005;436:456–8.

    Article  CAS  PubMed  Google Scholar 

  8. Karpanen T, Egeblad M, Karkkainen MJ, et al. Vascular endothelial growth factor C promotes tumor lymphangiogenesis and intralymphatic tumor growth. Cancer Res. 2001;61:1786–90.

    PubMed  CAS  Google Scholar 

  9. Cuneo B, Marcille BM. Topographie des ganglions iliopelviens. Bull Mem Soc Anat Paris. 1901;86:653–63.

    Google Scholar 

  10. Gray H. The lymphatics of the abdomen and pelvis. In: Gray’s anatomy. 20th ed. New York: Bartlebycom; 1918. http://bartlebycom/107/180/html.

    Google Scholar 

  11. Lengele B, Hamoir M, Scalliet P, Gregoire V. Anatomical bases for the radiological delineation of lymph node areas. Major collecting trunks, head and neck. Radiother Oncol. 2007;85:146–55.

    Article  PubMed  Google Scholar 

  12. Poirier P, Cunéo B, Delamere G. The lymphatics. Westminster: Archibald Constable; 1903.

    Google Scholar 

  13. Warwick R, Williams P. Topography of the lymph nodes and vessels. In: Gray’s anatomy. Edinburgh: Longman; 1973. p. 727–44.

    Google Scholar 

  14. Plentl A, Friedman E. Lymphatic system of the female genitalia. The morphologic basis of oncologic diagnosis and therapy. Philadelphia: Saunders; 1971.

    Google Scholar 

  15. Whitemore I. Lymphoid system. In: Federative commitee on anatomical terminology—terminologica anatomica. Stuttgart: Thieme Verlag; 1998.

    Google Scholar 

  16. Sappey P. Des vaisseaux lymphatiques. In: Delahaye A, Lecrosnier E, editors. Traité d’anatomie descriptive, vol. 2. Paris; 1888. p. 731–842.

    Google Scholar 

  17. Henriksen E. The lymphatic spread of carcinoma of the cervix and of the body of the uterus; a study of 420 necropsies. Am J Obstet Gynecol. 1949;58:924–42.

    Article  CAS  PubMed  Google Scholar 

  18. Rouvière H, Tobias M. Anatomy of the human lymphatic system. Ann Arbor: Edward; 1938.

    Google Scholar 

  19. Smith JA Jr, Whitmore WF Jr. Regional lymph node metastasis from bladder cancer. J Urol. 1981;126:591–3.

    Article  PubMed  Google Scholar 

  20. Roth B, Wissmeyer MP, Zehnder P, et al. A new multimodality technique accurately maps the primary lymphatic landing sites of the bladder. Eur Urol. 2010;57:205–11.

    Article  PubMed  Google Scholar 

  21. Thoeny HC, Ross BD. Predicting and monitoring cancer treatment response with diffusion-weighted MRI. J Magn Reson Imaging. 2010;32:2–16.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Ganswindt U, Schilling D, Muller AC, Bares R, Bartenstein P, Belka C. Distribution of prostate sentinel nodes: a SPECT-derived anatomic atlas. Int J Radiat Oncol Biol Phys. 2011;79:1364–72.

    Article  PubMed  Google Scholar 

  23. Hegemann NS, Wenter V, Spath S, Kusumo N, Li M, Bartenstein P, Fendler WP, Stief C, Belka C, Ganswindt U. Distribution of prostate nodes: a PET/CT-derived anatomic atlas of prostate cancer patients before and after surgical treatment. Radiat Oncol. 2016;11:37. https://doi.org/10.1186/s13014-016-0615-9.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

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Correspondence to Martin C. Schumacher .

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Schumacher, M.C. (2018). Surgical Anatomy of Pelvic Lymph Nodes. In: John, H., Wiklund, P. (eds) Robotic Urology. Springer, Cham. https://doi.org/10.1007/978-3-319-65864-3_11

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  • DOI: https://doi.org/10.1007/978-3-319-65864-3_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-65863-6

  • Online ISBN: 978-3-319-65864-3

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