Retroperitoneal Node Dissection

Abstract

Node dissection of the external iliac, obturator, common iliac, and preaortic-precaval nodes is performed for primary tumors of the pelvis with a tendency for lymphatic spread, such as gynecologic tumors, genitourinary tumors, and colorectal tumors. The precise extent of node dissection depends on the known propensity of the specific tumor to spread to a certain area of the retroperitoneal nodal chain and on radiologic evidence (e.g., CT scan) detecting involvement of specific nodes. The extent of this dissection superiorly stops at the level of the renal vessels. It is possible to go a few centimeters higher by kocherizing the duodenum and exposing the inferior vena cava (IVC) and aorta behind the pancreas. Mobilization of the spleen and distal pancreas anteriorly by dividing the splenocolic and lienorenal ligaments (and usually the gastrosplenic ligament) allows the spleen to be brought to the surface of the wound and provides adequate exposure of the upper abdominal aorta, the celiac axis, and the superior mesenteric artery for the removal of abnormally enlarged nodes in this area.