Multidisciplinary prospective study of standardized pelvic lymph-node dissection focusing on the dorsal obturator nerve region

TL;DR

This study evaluated a standardized approach to pelvic lymph-node dissection across multiple surgical specialties, focusing on the dorsal obturator nerve region.

Contribution

The study introduces a multidisciplinary, standardized anatomical framework for pelvic lymph-node dissection.

Findings

Over 90% of surgeons found the anatomical classification clear and feasible.

Dissecting the dorsal obturator nerve region added 15 minutes to operative time without improving lymph-node yield.

No major complications were observed in 96% of patients, and quality of life returned to baseline within a month.

Abstract

Pelvic lymph-node dissection is performed across multiple surgical specialties. However, inconsistent terminology and unclear anatomical boundaries hinder standardization. This study established a multidisciplinary team with a shared anatomical understanding, with the aim to prospectively evaluate standardized pelvic lymph-node dissection, focusing on the dorsal region of the obturator nerve.

A prospective observational study was conducted at a single institution from November 2022 to 2025. A team of urology, gastrointestinal surgery, gynecology, and pathology specialists received standardized anatomical training. A total of 106 patients undergoing pelvic lymph-node dissection for pelvic cancers were enrolled. Pelvic regions were predefined into seven areas. Data on surgical outcomes, lymph-node yield, complications, operative time, and quality of life were collected. Central pathology review and photographic scoring were performed.

Over 90% of surgeons rated the anatomical classification as clear. Planned lymphadenectomy was completed in over 95% of cases. The obturator region was consistently dissected. Dissection of the dorsal obturator nerve region did not increase the number of retrieved or positive lymph nodes but extended operative time by 15 min per side. No lymphadenectomy-related complications were observed in 96% of patients. Quality of life declined at 1 week postoperatively and stabilized by 1 month.

A multidisciplinary, standardized approach to pelvic lymph-node dissection is feasible and facilitates implementation across specialties. Dissection of the dorsal obturator nerve region increases operative time without demonstrating additional oncological advantage in this study. Standardized anatomical frameworks may facilitate safer and more consistent practice.

Figures