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Contribution of the cadaveric recirculation system in the anatomical study of lymphatic drainage of the ovary: applications in the management of ovarian cancer

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Abstract

Purpose

The present knowledge about lymphatic drainage of the ovary is based on carcinological studies, but it has only rarely been studied under physiological conditions. However, it is one of the preferential routes of dissemination in ovarian cancer, and understanding it is therefore vital for optimal carcinological management.Our purpose was to evaluate the feasibility of an innovative technique to study the lymphatic drainage territories of the ovary using a recirculation module on the cadaveric model.

Methods

We injected patent blue into the cortex of twenty “revascularised” cadaver ovaries with the Simlife recirculation model. We observed the migration of the dye live and described the drainage territories of each ovary.

Results

We observed a staining of the lymphatic vessels and migration of the dye in all the subjects, systematically ipsilateral to the injected ovary. We identified a staining of the lumbo-aortic territory in 65% of cases, with a preferential lateral-caval involvement (60%) for the right ovary and lateral-aortic territory (40%) for the left ovary. A common iliac involvement was observed in only 10% of cases. In 57% of cases, the staining of the lumbo-aortic territory was associated with a staining of the suspensory ligament. The pelvic territory was involved in 50% of cases, with an external iliac staining in 25% of cases and internal in 20%.

Conclusion

Our study provides for a better understanding of lymphatic drainage of the ovary using a new detection method, and allows the possibility of improving the teaching for operators with a realistic model. Continuation of this work could lead to considering more targeted and thus less morbid lymph node sampling for lymph node staging in early-stage ovarian cancer.

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Authors and Affiliations

  1. Département de chirurgie gynécologique, Chu Bretonneau Tours, Tours, 37000, France

    Floriane Murris, Lobna Ouldamer & Julie Delvallee

  2. Département de chirurgie gynécologique chu Rangueil Toulouse et laboratoire d’anatomie chu Rangueil Toulouse, Toulouse, 31000, France

    Ariane Weyl & Elodie Chantalat

  3. Oréliance, Saran, 45770, France

    Jérôme Lorenzini

  4. Département de chirurgie gynécologique, IUCT Oncopole, Toulouse, 31000, France

    Alejandra Martinez, Gwenael Ferron & Charlotte Chollet

  5. Département de neurochirurgie chu Pierre Paul Riquet Toulouse et laboratoire d’anatomie chu Toulouse, Toulouse, 31000, France

    Amaury De Barros

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  1. Floriane Murris
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Contributions

FM, AW and EC wrote the main manuscript text and prepared all the figures AM, GF and LO gave their opinion on the clinical application and revised it critically for important intellectual contentJD, JL, CC, AB approved the version to be publishedAll authors reviewed the manuscript.

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Correspondence to Floriane Murris.

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Murris, F., Weyl, A., Ouldamer, L. et al. Contribution of the cadaveric recirculation system in the anatomical study of lymphatic drainage of the ovary: applications in the management of ovarian cancer. Surg Radiol Anat (2024). https://doi.org/10.1007/s00276-024-03406-w

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