Abstract
Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.
Highlights
Figure rightaortic aorticupper upperpolar polarrenal renal artery with precaval course, which arises the anterolateral aspect of the abdominal aorta
We propose a classification according to the dissection the supra/inframesenteric be meticulous
The existence of vessel variations in the paraaortic regions is not uncommon as well as these variations significantly increase the risk of iatrogenic injury during Paraaortic lymph node dissection (PALND) in gynecologic oncology
Summary
—common iliac vein, IVC—inferior vena cava, AA—abdominal aorta, PMM—psoas major muscle, Ur—ureter, Cr—cranial, Ca—caudal, L—left, R—right. Skip metastasis in the supramesenteric region was found in 18% of lymph nodes retrieved, without the presence of a metastases inframesenteric region [17] According to these studies, we concluded that the LRV should be considered as the ventral limit of PALND for patients with cervical cancer and suspected PALNs’ metastases
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