Surgical Anatomy of Pelvic Lymph Nodes

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 (Sobin et al., TNM classification of malignant tumors, 2009). 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.