Pelvic lymphadenectomy in cervical cancer--surgical anatomy and proposal for a new classification system.
BACKGROUND
Pelvic lymphadenectomy is an integral component of gynecologic cancer surgery, yet there is a lack of standardization in the terminology used, the extent of the procedure, and the definition of anatomic landmarks. This lack of standardization if corrected will likely facilitate a more clear communication and analysis of outcomes from various institutions, and reduce confusion to trainees about the procedure being performed.


METHODS
We summarize the anatomic data concerning pelvic lymphatic drainage; describe the procedure based on clearly defined anatomic landmarks; and finally propose a new classification system to facilitate standardization, communication, and comparison of results. The accompanying video demonstrates the anatomic landmarks.


RESULTS
We list and define four commonly used terms related to pelvic lymph node harvesting: sentinel node mapping, excision of bulky nodes, pelvic lymph node sampling, and systematic pelvic lymphadenectomy. We list the five specific anatomic regions of the pelvic lymphatic basin: external iliac, obturator, internal iliac, common iliac, and presacral. We highlight the important neural structures located in regions of the pelvic lymphadenectomy: genitofemoral nerve, obturator nerve, cranial part of the lumbosacral plexus, hypogastric plexus, and splanchnic nerves. Finally, we propose a new, four-part classification system of types of pelvic lymph node dissection.


CONCLUSIONS
In this report and video, we demonstrate anatomy and offer a new classification system for pelvic lymphadenectomy.
Cibula
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Oncogynecological Centre, Department of Obstetrics and Gynecology, General Faculty Hospital, First Medical Faculty, Charles University, Apolinarska 18 Prague 2, 12000, Czech Republic. david.cibula@iol.cz
Abu-Rustum
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D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000145:classification / Q000379:methods* / Q000592:standards; D008198:Lymph Nodes / Q000033:anatomy & histology / Q000473:pathology / Q000601:surgery*; D010388:Pelvis / Q000033:anatomy & histology / Q000601:surgery; D009626:Terminology as Topic; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*