Department of Neurosciences, Institute of Human Anatomy, University of Padova, Padova, Italy.
Department of Surgery, Dentistry, Paediatrics and Gynaecology, Urologic Clinic University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Prostate. 2020 Feb;80(2):153-161. doi: 10.1002/pros.23927. Epub 2019 Nov 20.
The evidence of pelvic lymph node metastases after radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is one of the strongest prognostic factors for poor oncologic outcome. The extent of PLND, although representing a crucial step in RP, is still controversial. Currently, there is a critical drawback in clinical practice due to the lack of congruence between the known lymphatic drainage and cancer dissemination despite defined management by a surgical approach. We hypothesized the existence of alternative pathways for the lymphatic drainage of the prostate currently not considered in clinical daily practice.
We carried out a literature review of the anatomic description of nodal drainage of prostate reported by online databases (MEDLINE/PubMed, EBSCO, Web of Science, Ovid, and Scopus) and the original texts since the 18th century, with an additional anatomical dissection on a human cadaver to confirm theoretical data.
The anatomical dissection study converged with the historical anatomical treatises in describing three groups of lymphatics devoted to carrying out prostatic nodal drainage. Apart from the ascending ducts from the cranial gland leading to the external iliac nodes; the lateral ducts leading to the hypogastric nodes; small lymphatic vessels from the posterior surface of the prostate, directed to the pararectal lymphatic plexus, in the direction of the lateral sacral lymph nodes and those at the sacral promontory (ie, pararectal and presacral lymph nodes) were observed.
Our preliminary findings demonstrate that lymphatic drainage of the prostate extends beyond standard nodal templates actually considered in surgical daily practice, despite the knowledge reported by historical anatomical treatises. Further anatomical and experimental evidence are needed to investigate anatomical variability in humans, as well as to add more topographical details.
根治性前列腺切除术（RP）后盆腔淋巴结清扫术（PLND）中盆腔淋巴结转移的证据是预后不良的最强预测因素之一。PLND 的范围虽然代表 RP 中的一个关键步骤，但仍存在争议。目前，由于尽管通过手术方法进行了明确的管理，但已知的淋巴引流和癌症扩散之间缺乏一致性，因此在临床实践中存在一个关键的缺陷。我们假设目前在临床实践中未考虑到前列腺淋巴引流的替代途径的存在。
我们对在线数据库（MEDLINE/PubMed、EBSCO、Web of Science、Ovid 和 Scopus）和自 18 世纪以来的原始文本中报告的前列腺淋巴结引流的解剖学描述进行了文献回顾，并对人体尸体进行了额外的解剖学研究，以确认理论数据。
解剖研究与历史解剖论文集一致，描述了三组淋巴管，专门用于进行前列腺淋巴结引流。除了从颅腺向上引流至髂外淋巴结的升管；向耻骨下淋巴结引流的侧管；来自前列腺后表面的小淋巴管，向直肠旁淋巴丛，向侧骶淋巴结和骶骨突（即直肠旁和骶前淋巴结）方向引流。
我们的初步发现表明，尽管历史解剖论文集中有报道，但前列腺的淋巴引流超出了手术日常实践中实际考虑的标准淋巴结模板。需要进一步的解剖学和实验证据来研究人类的解剖学变异性，并添加更多的解剖细节。
