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Background <p>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.</p> Methods <p>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.</p> Results <p>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&#xa0;min per side. No lymphadenectomy-related complications were observed in 96% of patients. Quality of life declined at 1&#xa0;week postoperatively and stabilized by 1&#xa0;month.</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月24日

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  • Tomokazu Sazuka,
  • Yuji Habu,
  • Keisuke Matsusaka,
  • Tetsuro Maruyama,
  • Takayuki Arai,
  • Hiroaki Sato,
  • Keisuke Ando,
  • Manato Kanesaka,
  • Shinpei Saito,
  • Sangjon Pae,
  • Yusuke Imamura,
  • Hirokazu Usui,
  • Ayumu Matsuoka,
  • Natsuko Nakamura,
  • Rie Okuya,
  • Nozomi Sakai,
  • Eri Katayama,
  • Toru Tochigi,
  • Atsushi Hirata,
  • Takeshi Sugawara,
  • Jun-ichiro Ikeda,
  • Gaku Ohira,
  • Kaori Koga,
  • Shinichi Sakamoto

摘要

Background

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.

Methods

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.

Results

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.

Conclusions

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.