Pelvic and Para‐aortic Lymphadenectomy in Gynecologic Cancers

Abstract

Summary This chapter discusses pelvic and para-aortic lymphadenectomy in gynecologic cancers, citing the case of a 62-year-old woman was diagnosed to have uterine serous carcinoma on endometrial biopsy. She underwent total hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymphadenectomy, para-aortic node sampling, and omental biopsy. Histology revealed metastatic involvement of right external iliac node (stage IIIC1). Pelvic and para-aortic lymphadenectomy is a common surgical procedure in gynecologic oncology. While lymphadenectomy is not part of the staging for cervical cancer, it can provide prognostic information. Pelvic and para-aortic lymphadenectomy can be performed via a laparotomy or laparoscopy. Anatomic boundaries for pelvic lymphadenectomy include common iliac bifurcation superiorly, deep circumflex vein inferiorly, genitofemoral nerve on the iliopsoas muscle laterally, and obliterated umbilical artery medially. Pelvic lymphadenectomy can involve the removal of external iliac, internal iliac, obturator, and presacral nodes. Para-aortic lymphadenectomy can involve the removal of pre-aortic, precaval, para-aortic, paracaval, and retro-aortic nodes.