title: The lymphatic drainage of the uterine cervix in adult fresh cadavers: anatomy and surgical implications.
abstract: OBJECTIVE
  To investigate the differences of the amount of paracervical lymphatic structures removed when performing classical type III, modified type II and nerve-sparing radical hysterectomy (RH).
  
  
  METHODS
  Open macroscopic or laparoscopic pelvic dissections in 18 fresh adult female cadavers after lymphatic channels and nodes staining by Lipiodol dye solution injection of the uterine cervix.
  
  
  RESULTS
  We distinguished three different lymphatic pathways: 1) the supraureteral paracervical pathway (vascular portion of paracervix-uterine artery and superficial uterine vein), identified in 96% of cases, and removed in all types of RH, 2) the infraureteral paracervical pathway (vascular portion of paracervix-deep uterine vein), identified in 22% of cases, and removed by type III and nerve-sparing RH, and 3) the neural paracervical pathway (nervous portion of paracervix), identified in 7% of cases, and removable only by type III RH. No evidence of stained lymphatic structures running into the vesicouterine and uterosacral ligaments was found.
  
  
  CONCLUSIONS
  Nerve-sparing RH offers the most effective ratio between oncological safety and surgical-related complications, and would be particularly useful in patients with high risk of paracervical involvement while our results suggest caution in the use of modified type II RH in patients at low-moderate risk of paracervical involvement, unless the use of adjuvant radiotherapy, because of the large amount of potentially lymph-bearing paracervical tissue leaved in situ. Classical type III RH affords the complete resection of all paracervical lymphatic pathways potentially draining the cervix, however this procedure implies a high risk of lesions of the autonomous nerves of pelvic organs.
authors.affiliation: Gynecologic Oncology Unit, Department of Oncology, Catholic University, Campobasso, Italy. alfercoli@yahoo.it
authors.forename: A
authors.initials: A
authors.lastname: Ercoli
authors.forename: V
authors.initials: V
authors.lastname: Delmas
authors.forename: V
authors.initials: V
authors.lastname: Iannone
authors.forename: A
authors.initials: A
authors.lastname: Fagotti
authors.forename: F
authors.initials: F
authors.lastname: Fanfani
authors.forename: G
authors.initials: G
authors.lastname: Corrado
authors.forename: G
authors.initials: G
authors.lastname: Ferrandina
authors.forename: G
authors.initials: G
authors.lastname: Scambia
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002584:Cervix Uteri / Q000098:blood supply* / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D042601:Lymphatic Vessels / Q000033:anatomy & histology* / Q000601:surgery; D008875:Middle Aged