Distal External Iliac Lymph Nodes in Early Cervical Cancer

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 94; no. 3; pp. 391 - 394
• Main Authors: HOFFMAN, MITCHEL S, PARSONS, MICHAEL, GUNASEKARAN, SIVASELVI, CAVANAGH, DENIS
• Format: Journal Article
• Language: English
• Published: New York, NY The American College of Obstetricians and Gynecologists 01.09.1999; Elsevier Science
• Subjects: Adult; Aged; Biological and medical sciences; Female; Follow-Up Studies; Humans; Iliac Vein; Lymph Node Excision - methods; Lymphatic Metastasis; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the genital tract and mammary gland; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - surgery; Human; Carcinoma; Intraoperative; Malignant tumor; Uterine cervix; Hysterectomy; Female genital diseases; Lymphadenectomy; Treatment; Surgery; Distal; Complication; Female; Technique; Uterine cervix diseases
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1016/S0029-7844(99)00310-5

OBJECTIVETo evaluate the utility of the deep circumflex iliac vein as a landmark for the caudal limit of external iliac lymphadenectomy for early cervical cancer. METHODSDuring dissection of the distal (caudal), anterior (ventral) aspect of the external iliac vessels in conjunction with radical hysterectomy for carcinoma of the cervix, a careful search was made for the deep circumflex iliac vein. Lymph nodes immediately above this vein were sent as adjacent and lymph nodes caudal to the vein were sent as distal. The distance from the vein to the femoral canal was measured. RESULTSSeventy-one women were studied over 40 months. Fifty-five had squamous cell carcinoma, 15 had adenocarcinoma, and one had adenosquamous carcinoma. The mean distance from the deep circumflex iliac vein to the femoral canal was 16 mm. Sixty-three patients had dissections distal to identified deep circumflex iliac veins and 49 (77%) of these had distal lymph nodes removed. The median number of pelvic lymph nodes removed was 24 (range nine to 68), and the median number of distal lymph nodes removed was 1.0 from each side. Lymph node metastases were found in 13 women (18%). One subject with multiple macroscopically positive nodes had a single positive distal lymph node. Thus, a small number of distal lymph nodes were found in most women with early invasive cervical cancer, and 8% of those with positive nodes had involvement of this nodal group. CONCLUSIONThe deep circumflex iliac vein was an appropriate landmark for the caudal limit of external iliac lymphadenectomy.