Lymph Node Metastases in Prostatic Cancer
One of the first descriptions of the lymphatics of the prostate was that of Paolo Mascagni in his magnificent Vasorum Lymphaticorum Corporis Humani Historia et Iconographia, published in 1787 (1). A more modern work was that of Cuneo and Marcille, who completed the definitive dissections of the pelvic lymphatics at the turn of this century, and which later became the foundation for the definitive description of the pelvic lymphatics by Rouvière (2,3). According to Rouviere, the lymphatic drainage of the prostate consists of four main trunks. The first and most numerous lymphatic trunks emerge from the posterior surface of the prostatic capsule and go to the external iliac pedicle. The second group of lymphatics travels with branches of the hemorrhoidal artery to the hypogastric nodes. The third pedicle arises from the posterior surface, courses posteriorly to the pre-sacral region and encounters the first lymph node usually at the level of second sacral foramina. Other lymphatics in this group proceed to the region of the sacral promontory. The fourth pedicle descends from the anterior surface of the floor of the perineum going with the internal pudendal artery, and around the ischial spine into the pelvis, terminating in a hypogastric node.
KeywordsProstatic Cancer Pelvic Lymphadenectomy Obturator Nerve Ischial Spine Sacral Promontory
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