Pelvic lymphadenectomy: Anatomic considerations

Abstract

The real significance of pelvic lymphadenectomy, cure or staging, is still unknown. The morbility of this procedure is surely proportional to the extension of lymph node ablation. Bleeding, intraoperative lesions of nervous structure (lumbo-sacral trunk) post-operative lymphocele, but also lesion of the inferior hypogastric plexus and pelvic branches are more frequent in the case of extended (all the hypogastric and pre-sacral lymph nodes) than limited procedures. Therefore pelvic lymphadenectomy in the case of urologic malignancy is obviously incomplete. Nevertheless the incidence of recurrences in the remaining lymphatic structure is neither high nor clinically significant an therefore the indication for limited procedures is reinforced.