title: Pattern analysis of regional spread and therapeutic lymph node dissection in cervical cancer based on ontogenetic anatomy.
abstract: OBJECTIVE
  In cervical cancer lymph node dissection is applied for regional tumor staging. Up to now, the use of (chemo)radiation in the nodal positive patient has prevented the exact pattern analysis of regional tumor spread and the evaluation of the therapeutic role of lymph node dissection. New surgical techniques founded on ontogenetic instead of functional anatomy for the treatment of cervical cancer dispensing with adjuvant radiotherapy offer the possibility to accurately determine the topography of regional lymph node metastases which is the prerequisite for optimized diagnostic and therapeutic lymph node dissection.
  
  
  METHODS
  Patients with cervical cancer FIGO stages IB-IIB were treated with total mesometrial resection (TMMR) and lymph node dissection after exposing the ontogenetic visceroparietal compartments of the female pelvis. Resected lymph nodes were allocated to regions topographically defined by the embryonic development of the iliac, lumbar and mesenteric lymph systems prior to histopathological assessment.
  
  
  RESULTS
  71 of 305 treated patients had lymph node metastases. Topographic distribution of these metastases at primary surgery and analysis of pelvic failures showed a spatial pattern related to the ontogenesis of the abdominopelvic lymphatic system. Five-year locoregional tumor control probability was 96% (95% CI: 94-98) for the whole group and 87% (95% CI: 77-97) for nodal positive patients.
  
  
  CONCLUSIONS
  The pattern of regional spread in cervical cancer can be comprehended and predicted from ontogenetic lymphatic compartments. In patients with early cervical cancer lymph node dissection based on ontogenetic anatomy achieves high regional tumor control without adjuvant radiation.
authors.affiliation: Department of Gynecology, University of Leipzig, Leipzig, Germany. michael.hoeckel@uniklinik-leipzig.de
authors.forename: Michael
authors.initials: M
authors.lastname: Höckel
authors.forename: Lars-Christian
authors.initials: LC
authors.lastname: Horn
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Tetsch
authors.forename: Jens
authors.initials: J
authors.lastname: Einenkel
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000196:embryology / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods; D010388:Pelvis; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D016019:Survival Analysis; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery