Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Diseases of the Colon & Rectum
Published in: Diseases of the Colon & Rectum 3/2004

01-03-2004 | Original Contribution

Anatomic Study of Lateral Pelvic Lymph Nodes: Implications in the Treatment of Rectal Cancer

Authors: César E. Canessa, M.D., Laura M. Miegge, M.D., Joaquin Bado, M.D., Claudio Silveri, M.D., Daniel Labandera, M.D.

Published in: Diseases of the Colon & Rectum | Issue 3/2004

Login to get access

PURPOSE

Lateral pelvic lymphadenectomy remains a controversial issue in rectal cancer surgery. Beyond clinical results, disagreement includes surgical anatomy aspects and definitions, as wells as lack of information about location, groups, and number of lymph nodes, all of which makes comparison of results difficult. We performed a systematic examination of the number and distribution of lateral pelvic lymph nodes using cadaveric dissection.

METHODS

Sixteen formalin-fixed cadavers were dissected (14 males). Dissection fields were divided according to the three surgical groups of pelvic wall lymph nodes: presacral, obturator, and hypogastric. Number and site of excised lymph nodes was recorded, noting neurovascular relationships.

RESULTS

A total of 458 lymph nodes were found, with a mean of 28.6 nodes per pelvis (range, 16-46). Lymph node size ranged from 2 to 13 mm. The highest number of lymph nodes was found in the obturator fossa group (mean, 7; range, 2-18). Hypogastric lymph nodes were found lying predominantly above the inferior hypogastric nerve plexus but reaching the deep pelvic veins.

CONCLUSIONS

The mean number of lymph nodes found in lateral pelvic wall compartments was 28.6 per specimen. The group containing most lymph nodes lies in the obturator fossa. Complete excision of hypogastric lymph nodes demands a deep pelvic dissection of neurovascular structures.
Literature
1.
DiSaia, PJ, Creasman, WT 1999Clinical gynecologic oncologyMosby-Year Book IncChicago
2.
Bochner, BH, Herr, HW, Reuter, VE 2001Impact of separate versus en bloc pelvic lymph node dissection on the number of the lymph nodes retrieved in cystectomy specimensJ Urol16622956
3.
Heidenreich, A, Varga, Z, Knobloch, R 2002Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasisJ Urol16716816
4.
Harnsberger, JR, Vernava, AM,III, Longo, WE 1994Radical abdominopelvic lymphadenectomy: historic perspective and current role in the surgical management of rectal cancerDis Colon Rectum377387
5.
Ruo, L, Guillem, JG 1999Major 20th-century advancements in the management of rectal cancerDis Colon Rectum4256378
6.
Bruch, H, Schwandner, O, Schiedeck, TH, Roblick, UJ 1999Actual standards and controversies on operative technique and lymph-node dissection in colorectal cancerLangenbecks Arch Surg38416775
7.
Hojo, K, Sawada, T, Moriya, Y 1989An analysis of survival and voiding, sexual function after wide iliopelvic lymphadenectomy in patients with carcinoma of the rectum, compared with conventional lymphadenectomyDis Colon Rectum3212833
8.
Takahashi, T, Ueno, M, Azekura, K, Ota, H 1997The lymphatic spread of rectal cancer. And the effect of dissection: Japanese contribution and experienceSoreide, ONorstein, J eds. Rectal cancer surgerySpringer-VerlagBerlin16580
9.
Enker, WE, Pilipshen, SJ, Heilweil, ML,  et al. 1986En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancerAnn Surg20342633
10.
Enker, WE, Thaler, HT, Cranor, ML, Polyak, T 1995Total mesorectal excision in the operative treatment of carcinoma of the rectumJ Am Coll Surg18133546
11.
MacFarlane, JK 1997Lateral node dissection—a critiqueSoreide, ONorstein, J eds. Rectal cancer surgerySpringer-VerlagBerlin25563
12.
Sugihara, K, Moriya, Y, Akasu, T, Fujita, S 1996Pelvic autonomic nerve preservation for patients with rectal carcinoma. Oncologic and functional outcomeCancer78187180
13.
Moriya, T, Takahashi, K, Yasuno, M 1998Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissectionLangenbecks Arch Surg38340915
14.
Takahashi, T, Ueno, M, Asekura, K, Ohta, H 2000Lateral node dissection and total mesorectal excision for rectal cancerDis Colon Rectum43S5968
15.
Uyama, I, Sugioka, A, Matsui, H,  et al. 2001Laparoscopic lateral node dissection with autonomic nerve preservation for advanced lower rectal cancerJ Am Coll Surg19357984
16.
Gill, IS, Clayman, RV 1994Laparoscopic pelvic lymphadenectomySurg Oncol Clin North Am33236
17.
Cutini, G, Gesuelli, GC, Sartelli, M,  et al. 2001The role of lymphoscintigraphy in rectal laparoscopic surgery: can the sentinel node concept be applied to rectal carcinoma?Surg Endosc1514403
18.
Shimoyama, M, Yamazaki, T, Suda, T, Hatakeyama, K 2003Prognostic significance of lateral lymph node micrometastases in lower rectal cancer: an immunohistochemical study with CAM5.2Dis Colon Rectum463339
19.
Quenú, H 1893Vaisseaux lymphatiques de l’anusBull Soc Anat Paris7399410
20.
Gerota, D 1895Die lymphgefôsse des rectums und des anusArchiv Anat Physiol18124056
21.
Villemin, F, Huard, P, Montagné, M 1925Recherches anatomiques sur les lymphatiques du rectum et l’anus. Leurs applications dans le traitement chirurgical du cancerRev Chir633980
22.
Dodlewski, G, Prudhomme, M 2000Embryology and anatomy of the anorectumSurg Clin North Am8031943
23.
Reinhold P. Contribution a l’etude des recidives post-operatoires du cancer rectal. Thesis de doct. Paris, 1924.
24.
Blair, JB, Holyoke, DA, Best, RR 1950A note on the lymphatics of the middle and lower rectum and anusAnat Rec10863544
25.
Sauer, I, Bacon, H 1951Influence of lateral spread of cancer of the rectum on radicality of operation and prognosisAm J Surg8111120
26.
Bacon, H, Sauer, I 1950Surgical treatment of cancer of the lower bowelCancer37738
27.
Deddish, M 1951Abdominopelvic lymph-node dissection in cancer of the rectum and distal colonCancer413646
28.
Stearns, MW,Jr, Deddish, MR 1959Five-year results of abdominopelvic lymph node dissection for carcinoma of the rectumDis Colon Rectum216972
29.
Grinnell, R 1966Lymphatic block with atypical and retrograde lymphatic metastases and spread in carcinoma of the colon and rectumAnn Surg16327280
30.
Glass, RE, Ritchie, JK, Thompson, HR, Mann, CV 1985The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomyBr J Surg72599601
31.
Enker, W, Pilipshen, S, Heilweil, M,  et al. 1986En bloc pelvic lymphadenectomy and sphincter preservation in the surgical management of rectal cancerAnn Surg20342633
32.
Michelassi, F, Block, G, Vannucci, L, Montag, A, Chappell, R 1988A 5 to 21 year follow up and analysis of 250 patients with rectal adenocarcinomaAnn Surg20837989
33.
Senba, Y 1927An anatomical study of lymphatic system of the rectum (in Japanese)J Hukuoka Med Coll20121368
34.
Koyama, Y, Moriya, Y, Hojo, K 1984Effects of extended systematic lymphadenectomy for adenocarcinoma of the rectum—significant improvement of survival rate and decrease of local recurrenceJpn J Clin Oncol1462332
35.
Smith, PH, Ballatyne, B 1968The neuroanatomical basis for denervation of the urinary bladder following major pelvic surgeryBr J Surg5592933
36.
Lee, JF, Maurer, VM, Block, GE 1973Anatomic relations of pelvic autonomic nerves to pelvic operationsArch Surg1073248
37.
Walsh, PC, Schlegel, PN 1988Radical pelvic surgery with preservation of sexual functionAnn Surg208291300
38.
Gilchrist, RK, David, VC 1938Lymphatic spread of carcinoma of the rectumAnn Surg10862137
39.
Moriya, Y, Hojo, K, Sawada, T, Koyama, Y 1989Significance of lateral node dissection for advanced rectal carcinoma at or below the peritoneal reflectionDis Colon Rectum3230715
40.
Mascagni, D, Hojo, K, Moriya, Y, Sugihara, K, Matteo, G 1992Pattern of lymph node metastasis form low rectal cancer (meeting abstract)Dis Colon Rectum35P6
41.
Moreira, LF, Hizuta, A, Iwagaki, H, Tanaka, N, Orita, K 1994Lateral lymph node dissection for rectal carcinoma below the peritoneal reflectionBr J Surg812936
42.
Morikawa, E, Yasutomi, M, Shindou, K,  et al. 1994Distribution of metastatic lymph nodes in colorectal cancer by the modified clearing methodDis Colon Rectum3721923
43.
Mori, T, Takahashi, K, Yasuno, M 1998Radical resection with autonomic nerve preservation and lymph node dissection techniques in lower rectal cancer surgery and its results: the impact of lateral lymph node dissectionLangenbecks Arch Surg38340915
44.
Steup, WH, Moriya, Y, Velde, CJ 2002Patterns of lymphatic spread in rectal cancer. A topographical analysis on lymph node metastasesEur J Cancer389118
45.
Moriya, Y 1997Importance of lymphatic spreadSoreide, ONorstein, J eds. Rectal cancer surgerySpringer-VerlagBerlin15364
46.
Ueno, H, Mochizuki, H, Sinto, E,  et al. 2002Histologic indices in biopsy specimens for estimating the probability of extended local spread in patients with rectal carcinomaCancer94288291
47.
McDowell, GC, Johnson, J, Tenney, D, Johnson, D 1990Pelvic lymphadenectomy for staging clinically localized prostate cancerUrology3517682
48.
Akasu, T, Moriya, Y 1997Abdominopelvic lymphadectomy with autonomic nerve preservation for carcinoma of the rectum: Japanese experienceWanebo, HJ eds. Surgery for gastrointestinal cancer: a multidisciplinary approachLippincott-RavenPhiladelphia66780
49.
Hojo, K, Vernava, AM,III, Sugihara, K, Katumata, K 1991Preservation of urine voiding and sexual function after rectal cancer surgeryDis Colon Rectum345329
50.
Hollabaugh, RS,Jr, Steiner, MS, Sellers, KD, Samm, BJ, Dmochowski, RR 2000Neuroanatomy of the pelvis: implications for colonic and rectal resectionDis Colon Rectum4313907
51.
Rouvière, H 1932Anatomie des lymphatiques de l’hommeMasson et CieParis
52.
Panici, PB, Scambia, G, Baiocchi, G,  et al. 1992Anatomical study of para-aortic and pelvic lymph nodes in gynecologic malignanciesObstet Gynecol79498502
53.
MacFarlane, JK, Ryall, RD, Heald, RJ 1993Mesorectal excision for rectal cancerLancet34145760
54.
Havenga, K, Enker, WE, Norstein, J,  et al. 1999Improved survival and local control after total mesorectal excision or D3 lymphadenectomy in the treatment of primary rectal cancer: an international analysis of 1411 patientsEur J Surg Oncol2536874
55.
Heald, RJ, Smedh, RK, Kald, A, Sexton, R, Moran, BJ 1997Abdominoperineal excision of the rectum—an endangered operationDis Colon Rectum4074751
56.
Enker, WE, Havenga, K, Polyak, T, Thaler, H, Cranor, M 1997Abdomino-perineal resection via total mesorectal excision and autonomic nerve preservation for low rectal cancerWorld J Surg2171520
57.
Holm, T, Johansson, H, Rutqvist, LE, Cedermark, B 2001Tumour location and the effects of preoperative radiotherapy in the treatment of rectal cancerBr J Surg8883943
58.
Bonadeo, FA, Vaccaro, CA, Benati, ML, Ojea Quintana, GM, Garione, XE, Telenta, MT 2001Rectal cancer: local recurrence after surgery without radiotherapyDis Colon Rectum443749
59.
Kapiteijn, E, Marijnen, CA, Nagtegall, ID,  et al. 2001Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancerN Engl J Med34563846
60.
Phang, PT, MacFarlane, JK, Taylor, RH,  et al. 2002Effects of positive resection margin and tumor distance from anus on rectal cancer treatment outcomesAm J Surg1835048
61.
MacFarlane, JK 1996Nodal metastases in rectal cancer. The role of surgery in outcomeSurg Oncol Clin North Am5191202
62.
Enker, WE, Havenga, K, Thaler, HT,  et al. 1997Total mesorectal excision with pelvic autonomic nerve preservationSoreide, ONorstein, J eds. Rectal cancer surgerySpringer-VerlagBerlin22043
63.
Hida, J, Yasutomi, M, Fujimoto, K,  et al. 1997Does lateral lymph node dissection improve survival in rectal carcinoma? Examination of node metastases by the clearing methodJ Am Coll Surg18447580
64.
Koyama, Y, Kotake, K 1997Overview of colorectal cancer in Japan: report from the Registry of the Japanese Society for Cancer of the Colon and RectumDis Colon Rectum40S29
65.
Saha, S, Nora, D, Wong, JH, Weise, D 2000Sentinel lymph node mapping in colorectal cancer—a reviewSurg Clin North Am8018119
66.
Tsioulias, GJ, Wood, TF, Morton, DL, Bilchnik, AJ 2000Lymphatic mapping and focused analysis of sentinel lymph nodes upstage gastrointestinal neoplasmsArch Surg13592632
Metadata
Title
Anatomic Study of Lateral Pelvic Lymph Nodes: Implications in the Treatment of Rectal Cancer
Authors
César E. Canessa, M.D.
Laura M. Miegge, M.D.
Joaquin Bado, M.D.
Claudio Silveri, M.D.
Daniel Labandera, M.D.
Publication date
01-03-2004
Publisher
Springer-Verlag
Published in
Diseases of the Colon & Rectum / Issue 3/2004
Print ISSN: 0012-3706
Electronic ISSN: 1530-0358
DOI
https://doi.org/10.1007/s10350-003-0052-3

Other articles of this Issue 3/2004

Diseases of the Colon & Rectum 3/2004 Go to the issue

Abstracts

Selected Abstracts

Original Contribution

Significance of Incidental Desmoids Identified During Surgery for Familial Adenomatous Polyposis

Original Contribution

A High Degree of Aneuploidy, Loss of p53 Gene, and Low Soluble p53 Protein Serum Levels Are Detected in Ulcerative Colitis Patients

Original Contribution

Colorectal Adenoma Characteristics as Predictors of Recurrence

Original Contribution

Three-Dimensional Anal Endosonography May Improve Staging of Anal Cancer Compared With Two-Dimensional Endosonography

Original Contribution

Rate of Pathologic Complete Response With Increased Interval Between Preoperative Combined Modality Therapy and Rectal Cancer Resection