Skip to main content

Advertisement

SpringerLink
Log in

Anatomic Study of Lateral Pelvic Lymph Nodes: Implications in the Treatment of Rectal Cancer

  • Original Contribution
  • Published:
Diseases of the Colon & Rectum

PURPOSE

Lateral pelvic lymphadenectomy remains a controversial issue in rectal cancer surgery. Beyond clinical results, disagreement includes surgical anatomy aspects and definitions, as wells as lack of information about location, groups, and number of lymph nodes, all of which makes comparison of results difficult. We performed a systematic examination of the number and distribution of lateral pelvic lymph nodes using cadaveric dissection.

METHODS

Sixteen formalin-fixed cadavers were dissected (14 males). Dissection fields were divided according to the three surgical groups of pelvic wall lymph nodes: presacral, obturator, and hypogastric. Number and site of excised lymph nodes was recorded, noting neurovascular relationships.

RESULTS

A total of 458 lymph nodes were found, with a mean of 28.6 nodes per pelvis (range, 16-46). Lymph node size ranged from 2 to 13 mm. The highest number of lymph nodes was found in the obturator fossa group (mean, 7; range, 2-18). Hypogastric lymph nodes were found lying predominantly above the inferior hypogastric nerve plexus but reaching the deep pelvic veins.

CONCLUSIONS

The mean number of lymph nodes found in lateral pelvic wall compartments was 28.6 per specimen. The group containing most lymph nodes lies in the obturator fossa. Complete excision of hypogastric lymph nodes demands a deep pelvic dissection of neurovascular structures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

REFERENCES

  1. PJ DiSaia WT Creasman (1999) Clinical gynecologic oncology Mosby-Year Book Inc Chicago

    Google Scholar 

  2. BH Bochner HW Herr VE Reuter (2001) ArticleTitleImpact of separate versus en bloc pelvic lymph node dissection on the number of the lymph nodes retrieved in cystectomy specimens J Urol 166 2295–6

    Google Scholar 

  3. A Heidenreich Z Varga R Knobloch Particlevon (2002) ArticleTitleExtended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis J Urol 167 1681–6

    Google Scholar 

  4. JR Harnsberger AM Vernava SuffixIII WE Longo (1994) ArticleTitleRadical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical management of rectal cancer Dis Colon Rectum 37 73–87

    Google Scholar 

  5. L Ruo JG Guillem (1999) ArticleTitleMajor 20th-century advancements in the management of rectal cancer Dis Colon Rectum 42 563–78

    Google Scholar 

  6. H Bruch O Schwandner TH Schiedeck UJ Roblick (1999) ArticleTitleActual standards and controversies on operative technique and lymph-node dissection in colorectal cancer Langenbecks Arch Surg 384 167–75

    Google Scholar 

  7. K Hojo T Sawada Y Moriya (1989) ArticleTitleAn analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomy Dis Colon Rectum 32 128–33

    Google Scholar 

  8. T Takahashi M Ueno K Azekura H Ota (1997) The lymphatic spread of rectal cancer. And the effect of dissection: Japanese contribution and experience O Soreide J Norstein (Eds) Rectal cancer surgery Springer-Verlag Berlin 165–80

    Google Scholar 

  9. WE Enker SJ Pilipshen ML Heilweil et al. (1986) ArticleTitleEn bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer Ann Surg 203 426–33

    Google Scholar 

  10. WE Enker HT Thaler ML Cranor T Polyak (1995) ArticleTitleTotal mesorectal excision in the operative treatment of carcinoma of the rectum J Am Coll Surg 181 335–46

    Google Scholar 

  11. JK MacFarlane (1997) Lateral node dissection—a critique O Soreide J Norstein (Eds) Rectal cancer surgery Springer-Verlag Berlin 255–63

    Google Scholar 

  12. K Sugihara Y Moriya T Akasu S Fujita (1996) ArticleTitlePelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcome Cancer 78 1871–80

    Google Scholar 

  13. T Moriya K Takahashi M Yasuno (1998) ArticleTitleRadical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection Langenbecks Arch Surg 383 409–15

    Google Scholar 

  14. T Takahashi M Ueno K Asekura H Ohta (2000) ArticleTitleLateral node dissection and total mesorectal excision for rectal cancer Dis Colon Rectum 43 S59–68

    Google Scholar 

  15. I Uyama A Sugioka H Matsui et al. (2001) ArticleTitleLaparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancer J Am Coll Surg 193 579–84

    Google Scholar 

  16. IS Gill RV Clayman (1994) ArticleTitleLaparoscopic pelvic lymphadenectomy Surg Oncol Clin North Am 3 323–6

    Google Scholar 

  17. G Cutini GC Gesuelli M Sartelli et al. (2001) ArticleTitleThe role of lymphoscintigraphy in rectal laparoscopic surgery: can the sentinel node concept be applied to rectal carcinoma? Surg Endosc 15 1440–3

    Google Scholar 

  18. M Shimoyama T Yamazaki T Suda K Hatakeyama (2003) ArticleTitlePrognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2 Dis Colon Rectum 46 333–9

    Google Scholar 

  19. H Quenú (1893) ArticleTitleVaisseaux lymphatiques de l’anus Bull Soc Anat Paris 7 399–410

    Google Scholar 

  20. D Gerota (1895) ArticleTitleDie lymphgefôsse des rectums und des anus Archiv Anat Physiol 181 240–56

    Google Scholar 

  21. F Villemin P Huard M Montagné (1925) ArticleTitleRecherches anatomiques sur les lymphatiques du rectum et l’anus. Leurs applications dans le traitement chirurgical du cancer Rev Chir 63 39–80

    Google Scholar 

  22. G Dodlewski M Prudhomme (2000) ArticleTitleEmbryology and anatomy of the anorectum Surg Clin North Am 80 319–43

    Google Scholar 

  23. Reinhold P. Contribution a l’etude des recidives post-operatoires du cancer rectal. Thesis de doct. Paris, 1924.

  24. JB Blair DA Holyoke RR Best (1950) ArticleTitleA note on the lymphatics of the middle and lower rectum and anus Anat Rec 108 635–44

    Google Scholar 

  25. I Sauer H Bacon (1951) ArticleTitleInfluence of lateral spread of cancer of the rectum on radicality of operation and prognosis Am J Surg 81 111–20

    Google Scholar 

  26. H Bacon I Sauer (1950) ArticleTitleSurgical treatment of cancer of the lower bowel Cancer 3 773–8

    Google Scholar 

  27. M Deddish (1951) ArticleTitleAbdominopelvic lymph-node dissection in cancer of the rectum and distal colon Cancer 4 1364–6

    Google Scholar 

  28. MW Stearns SuffixJr MR Deddish (1959) ArticleTitleFive-year results of abdominopelvic lymph node dissection for carcinoma of the rectum Dis Colon Rectum 2 169–72

    Google Scholar 

  29. R Grinnell (1966) ArticleTitleLymphatic block with atypical and retrograde lymphatic metastases and spread in carcinoma of the colon and rectum Ann Surg 163 272–80

    Google Scholar 

  30. RE Glass JK Ritchie HR Thompson CV Mann (1985) ArticleTitleThe results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy Br J Surg 72 599–601

    Google Scholar 

  31. W Enker S Pilipshen M Heilweil et al. (1986) ArticleTitleEn bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancer Ann Surg 203 426–33

    Google Scholar 

  32. F Michelassi G Block L Vannucci A Montag R Chappell (1988) ArticleTitleA 5 to 21 year follow up and analysis of 250 patients with rectal adenocarcinoma Ann Surg 208 379–89

    Google Scholar 

  33. Y Senba (1927) ArticleTitleAn anatomical study of lymphatic system of the rectum (in Japanese) J Hukuoka Med Coll 20 1213–68

    Google Scholar 

  34. Y Koyama Y Moriya K Hojo (1984) ArticleTitleEffects of extended systematic lymphadenectomy for adenocarcinoma of the rectum—significant improvement of survival rate and decrease of local recurrence Jpn J Clin Oncol 14 623–32

    Google Scholar 

  35. PH Smith B Ballatyne (1968) ArticleTitleThe neuroanatomical basis for denervation of the urinary bladder following major pelvic surgery Br J Surg 55 929–33

    Google Scholar 

  36. JF Lee VM Maurer GE Block (1973) ArticleTitleAnatomic relations of pelvic autonomic nerves to pelvic operations Arch Surg 107 324–8

    Google Scholar 

  37. PC Walsh PN Schlegel (1988) ArticleTitleRadical pelvic surgery with preservation of sexual function Ann Surg 208 291–300

    Google Scholar 

  38. RK Gilchrist VC David (1938) ArticleTitleLymphatic spread of carcinoma of the rectum Ann Surg 108 621–37

    Google Scholar 

  39. Y Moriya K Hojo T Sawada Y Koyama (1989) ArticleTitleSignificance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflection Dis Colon Rectum 32 307–15

    Google Scholar 

  40. D Mascagni K Hojo Y Moriya K Sugihara G Matteo ParticleDi (1992) ArticleTitlePattern of lymph node metastasis form low rectal cancer (meeting abstract) Dis Colon Rectum 35 P6

    Google Scholar 

  41. LF Moreira A Hizuta H Iwagaki N Tanaka K Orita (1994) ArticleTitleLateral lymph node dissection for rectal carcinoma below the peritoneal reflection Br J Surg 81 293–6

    Google Scholar 

  42. E Morikawa M Yasutomi K Shindou et al. (1994) ArticleTitleDistribution of metastatic lymph nodes in colorectal cancer by the modified clearing method Dis Colon Rectum 37 219–23

    Google Scholar 

  43. T Mori K Takahashi M Yasuno (1998) ArticleTitleRadical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissection Langenbecks Arch Surg 383 409–15

    Google Scholar 

  44. WH Steup Y Moriya CJ Velde Particlevan de (2002) ArticleTitlePatterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastases Eur J Cancer 38 911–8

    Google Scholar 

  45. Y Moriya (1997) Importance of lymphatic spread O Soreide J Norstein (Eds) Rectal cancer surgery Springer-Verlag Berlin 153–64

    Google Scholar 

  46. H Ueno H Mochizuki E Sinto et al. (2002) ArticleTitleHistologic indices in biopsy specimens for estimating the probability of extended local spread in patients with rectal carcinoma Cancer 94 2882–91

    Google Scholar 

  47. GC McDowell J Johnson D Tenney D Johnson (1990) ArticleTitlePelvic lymphadenectomy for staging clinically localized prostate cancer Urology 35 176–82

    Google Scholar 

  48. T Akasu Y Moriya (1997) Abdominopelvic lymphadectomy with autonomic nerve preservation for carcinoma of the rectum: Japanese experience HJ Wanebo (Eds) Surgery for gastrointestinal cancer: a multidisciplinary approach Lippincott-Raven Philadelphia 667–80

    Google Scholar 

  49. K Hojo AM Vernava SuffixIII K Sugihara K Katumata (1991) ArticleTitlePreservation of urine voiding and sexual function after rectal cancer surgery Dis Colon Rectum 34 532–9

    Google Scholar 

  50. RS Hollabaugh SuffixJr MS Steiner KD Sellers BJ Samm RR Dmochowski (2000) ArticleTitleNeuroanatomy of the pelvis: implications for colonic and rectal resection Dis Colon Rectum 43 1390–7

    Google Scholar 

  51. H Rouvière (1932) Anatomie des lymphatiques de l’homme Masson et Cie Paris

    Google Scholar 

  52. PB Panici G Scambia G Baiocchi et al. (1992) ArticleTitleAnatomical study of para-aortic and pelvic lymph nodes in gynecologic malignancies Obstet Gynecol 79 498–502

    Google Scholar 

  53. JK MacFarlane RD Ryall RJ Heald (1993) ArticleTitleMesorectal excision for rectal cancer Lancet 341 457–60

    Google Scholar 

  54. K Havenga WE Enker J Norstein et al. (1999) ArticleTitleImproved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patients Eur J Surg Oncol 25 368–74

    Google Scholar 

  55. RJ Heald RK Smedh A Kald R Sexton BJ Moran (1997) ArticleTitleAbdominoperineal excision of the rectum—an endangered operation Dis Colon Rectum 40 747–51

    Google Scholar 

  56. WE Enker K Havenga T Polyak H Thaler M Cranor (1997) ArticleTitleAbdomino-perineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancer World J Surg 21 715–20

    Google Scholar 

  57. T Holm H Johansson LE Rutqvist B Cedermark (2001) ArticleTitleTumour location and the effects of preoperative radiotherapy in the treatment of rectal cancer Br J Surg 88 839–43

    Google Scholar 

  58. FA Bonadeo CA Vaccaro ML Benati GM Ojea Quintana XE Garione MT Telenta (2001) ArticleTitleRectal cancer: local recurrence after surgery without radiotherapy Dis Colon Rectum 44 374–9

    Google Scholar 

  59. E Kapiteijn CA Marijnen ID Nagtegall et al. (2001) ArticleTitlePreoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer N Engl J Med 345 638–46

    Google Scholar 

  60. PT Phang JK MacFarlane RH Taylor et al. (2002) ArticleTitleEffects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomes Am J Surg 183 504–8

    Google Scholar 

  61. JK MacFarlane (1996) ArticleTitleNodal metastases in rectal cancer. The role of surgery in outcome Surg Oncol Clin North Am 5 191–202

    Google Scholar 

  62. WE Enker K Havenga HT Thaler et al. (1997) Total mesorectal excision with pelvic autonomic nerve preservation O Soreide J Norstein (Eds) Rectal cancer surgery Springer-Verlag Berlin 220–43

    Google Scholar 

  63. J Hida M Yasutomi K Fujimoto et al. (1997) ArticleTitleDoes lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing method J Am Coll Surg 184 475–80

    Google Scholar 

  64. Y Koyama K Kotake (1997) ArticleTitleOverview of colorectal cancer in Japan: report from the Registry of the Japanese Society for Cancer of the Colon and Rectum Dis Colon Rectum 40 S2–9

    Google Scholar 

  65. S Saha D Nora JH Wong D Weise (2000) ArticleTitleSentinel lymph node mapping in colorectal cancer—a review Surg Clin North Am 80 1811–9

    Google Scholar 

  66. GJ Tsioulias TF Wood DL Morton AJ Bilchnik (2000) ArticleTitleLymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasms Arch Surg 135 926–32

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anatomy and Surgical Department “A,” School of Medicine, Universidad de la República, Montevideo, Uruguay

    César E. Canessa M.D.

  2. Department of Anatomy and Faculty of Medicine, School of Medicine, Universidad de la República, Montevideo, Uruguay

    Laura M. Miegge M.D., Joaquin Bado M.D., Claudio Silveri M.D. & Daniel Labandera M.D.

Authors
  1. César E. Canessa M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura M. Miegge M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joaquin Bado M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Claudio Silveri M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Labandera M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to César E. Canessa M.D..

About this article

Cite this article

Canessa, C., Miegge, L., Bado, J. et al. Anatomic Study of Lateral Pelvic Lymph Nodes: Implications in the Treatment of Rectal Cancer. Dis Colon Rectum 47, 297–303 (2004). https://doi.org/10.1007/s10350-003-0052-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-003-0052-3

Keywords

Search

Navigation