Retroperitoneal lymph node dissection (RPLND)

Pelvic and paraaortic lymph nodes are common sites of metastases from gynecologic malignancies and may act as a sanctuary of chemoresistant tumor cells in some patients. There is no doubt that the evaluation of the regional lymph nodes provides important prognostic information for patients with gynecologic malignancies. The rationale is a more accurate assessment of the extent of disease, allowing for better individualization of adjuvant therapy. Nonetheless, the therapeutic role of systematic lymphadenectomy in patients with gynecologic malignancies is still under debate.The retroperitoneal lymph node dissection (RPLND) has been shown to prolong survival for patients with chemorefractory ovarian immature teratoma. Furthermore, RPLND is an important aspect of post-chemotherapy debulking surgery for nonseminomatous germ cell tumors, which is the counterpart of the ovarian immature teratoma. Therefore, the ability to perform an extensive RPLND is an important skill in the surgical armamentarium of the gynecologic oncologist. In the following article we outline the surgical anatomy and describe the essential steps of the RPLND.