Surgical Anatomy of Pelvic Lymph Nodes

Understanding of the anatomy and nomenclature of pelvic lymph node groups is essential for accurate staging of urogenital malignancies. According to clinical guidelines across surgical specialties, surgery performed with a curative intention involves removal of lymph nodes along lymphatic drainage routes. The aim is to accurately assess the extent of the disease and improve the prognosis of the disease. However, lymph node dissection templates recommended by major guidelines are not always consistent with each other [1]. The spread of pelvic tumors to loco-regional lymph nodes is an important means of tumor dissemination. Nodal metastases have therapeutic implications for prognosis and management. Pelvic tumors usually metastasize first to regional lymph nodes, which are specific groups of nodes for each type of tumor, and are classified according to the TNM system as N-stage disease [2]. If a pelvic tumor metastasizes to a lymph node outside of the defined regional nodes, this is considered M-stage disease, which may in turn affect the patient’s treatment options and prognosis. Thus, exact knowledge of the regional pelvic lymph node spread of each tumor located within the small pelvis is essential for diagnostic purposes, surgical treatment options, tumor staging and follow-up strategies. A key element in assessing each patient is the correct and precise anatomical description of pelvic nodal metastases to facilitate proper staging and treatment. In the present overview pelvic lymph node anatomy and nomenclature are reviewed with schematic illustrations.