Distal external iliac lymph nodes in early cervical cancer

Objective: To evaluate the utility of the deep circumflex iliac vein as a l andmark for the caudal limit of external iliac lymphadenectomy for early ce rvical cancer. Methods: During dissection of the distal (caudal), anterior (ventral) aspec t of the external iliac vessels in conjunction with radical hysterectomy fo r carcinoma of the cervix, a careful search was made for the deep circumfle x 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. Results: Seventy-one women were studied over 40 months. Fifty-five had squa mous cell carcinoma, 15 had adenocarcinoma, and one had adenosquamous carci noma. 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 re moved. The median number of pelvic lymph nodes removed was 24 (range nine t o 68), and the median number of distal lymph nodes removed was 1.0 from eac h side. Lymph node metastases were found in 13 women (18%). One subject wit h multiple macroscopically positive nodes had a single positive distal lymp h 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 h ad involvement of this nodal group. Conclusion: The deep circumflex iliac vein was an appropriate landmark for the caudal limit of external iliac lymphadenectomy. (C) 1999 by The America n College of Obstetricians and Gynecologists.