Lymphadenectomy is an integral part of gynecological
cancer surgery however there is still lack of standardization in the terminology used. In the current literature several types of
surgical procedures for pelvic lymph nodes dissection are recognized. Complete pelvic
lymphadenectomy is defined as the removal of all fatty lymphatic tissue from the predicted areas of high incidence of lymph nodes with possible metastatic involvement. Para-aortic
lymphadenectomy is defined as the removal of all lymphatic tissue from the aortic region. The latter is divided into two levels: the lower--up to the inferior mesenteric artery and the upper--up to the left renal vein. Another classification divided pelvic and aortic
lymphadenectomy into three classes. Class I is defined as the removal of the chosen lymph nodes, class II as the removal of lymph nodes located ventrally and laterally to the large retroperitoneal pelvic vessels, obturator nerves and laterally to the aorta and the inferior vena cava, whereas class III as the complete removal of lymphatic tissue surrounding the iliac vessels, obturator pits, dorsally to the obturator nerve and the presacral lymph tissue around the aorta and the inferior vena cava. In each gynecological
cancer depending on the severity of the disease different procedures are applied concerning
lymphadenectomy. In patients with advanced
ovarian cancer systematic
lymphadenectomy prolongs the survival rate. Omission of systematic
lymphadenectomy can be considered only for patients with
mucinous carcinoma G1 level. In the case of
vulvar cancer removal of pelvic, iliac and obturator lymph nodes is inappropriate as it has not been proven to result in an increased survival rate. Inguinal
lymphadenectomy in this
cancer depends on the stage and location of the primary
tumor--at an early stage
vulvar cancer located laterally a superficial, unilateral inguinal
lymphadenectomy can be performed, if the primary lesion is located centrally an inguinal
lymphadenectomy should be performed on both sides. Deep inguinal
lymphadenectomy should be performed only in cases where: primary
tumor is located centrally in case of
cancer in the early stages, in advanced stage and in patients with
metastases in the superficial nodes. Sentinel lymph node biopsy is an alternative method that can be offered to patients with early-stage
vulvar cancer located laterally.
Lymphadenectomy in
endometrial cancer is beneficial in stages I G3, II and III. In stages I G1 and G2 an increase in the survival time has not been shown. The
cervical cancer stage IB-IIA removal of para-aortic lymph nodes (to the mesenteric artery) is indicated in patients with large
tumors and suspected or known disease in the pelvic nodes. In patients in whom diagnostic imaging studies have not shown
metastasis in para-aortic and pelvic lymph nodes or distant
metastasis, para-aortic
lymphadenectomy can be omitted. Further randomized studies are needed to elucidate the necessity and extent of
lymphadenectomy in given gynecological
cancers.