Pour quels cancers est-il indiqué ?

Principalement pour les cancers gynécologiques avancés ou de stade incertain : cancer de l'ovaire (stadification systématique en l'absence d'atteinte ganglionnaire visible au scanner), cancer du col stade ≥ IB2, cancer de l'endomètre à haut risque ou stade III, cancer des trompes de Fallope. Lymphadenectomy est aussi pratiqué dans certains cas de récidive.

Why enlever des ganglions sains ?

L'imagerie (scanner, IRM, TEP) ne détecte que les ganglions de plus de 1 cm. Or, des micrométastases peuvent être présentes dans des ganglions de taille normale. Lymphadenectomy permet de diagnostiquer ces atteintes infraradiologiques, qui changent souvent la stadification FIGO et donc le traitement adjuvant (chimiothérapie, radiothérapie). Pour le cancer de l'ovaire, lymphadenectomy fait partie de la chirurgie de cytoréduction qui vise à laisser zéro résidu tumoral macroscopique.

How l'intervention se déroule-t-elle ?

Sous anesthésie générale, par laparoscopy, robotique (Da Vinci) ou laparotomie selon le contexte. Pour un cancer ovarien suspect avec carcinose péritonéale, la voie laparotomique reste de référence pour permettre l'ensemble de la cytoréduction. Pour les stadifications de cancers de l'endomètre ou du col, the laparoscopic or robotic approach is preferred. L'intervention dure 2 à 5 heures selon l'étendue.

Quelle est la durée d'hospitalisation ?

3 à 5 jours après laparoscopy ou robotique seule. 5 à 7 jours après laparotomie ou chirurgie complète de cytoréduction. La récupération est plus longue qu'un sentinel node : reprise des activités quotidiennes sous 3 to 4 weeks, reprise du travail sous 6 to 8 weeks. Les suites incluent une prévention thrombo-embolique systématique.

Quels sont les risques du pelvic lymphadenectomy et lombo-aortique ?

Risques opératoires : plaie urétérale (1 à 3%), plaie vasculaire (vaisseaux iliaques ou aorte, <1%), plaie digestive (1 à 2%), saignement nécessitant transfusion (3 à 5%). Risques post-opératoires : lymphocèle pelvienne ou lombo-aortique (5 à 10%), lymphœdème des membres inférieurs (10 à 20%), thrombose veineuse profonde, occlusion intestinale tardive.

Lymphadenectomy est-il toujours nécessaire pour le cancer de l'ovaire ?

Oui, dans la grande majorité des cas. La stadification ganglionnaire est essentielle pour le cancer de l'ovaire, car elle conditionne le traitement adjuvant. Une exception : si le scanner pré-opératoire ne montre pas de ganglion suspect et que la cytoréduction est complète sans résidu, certaines équipes discutent d'a lymphadenectomy limité (étude LION 2019). En France, les recommandations Saint-Paul de Vence 2024-2025 maintiennent lymphadenectomy systématique dans la majorité des situations.

Pelvic & para-aortic lymphadenectomy Paris

Q: Qu'est-ce que lymphadenectomy pelvien et lombo-aortique ?

C'est l'ablation chirurgicale des ganglions lymphatiques du bassin (chaînes iliaques externes, internes, obturatrices) et de la région autour de l'aorte et de la veine cave (lombo-aortique). On retire en moyenne 20 à 40 ganglions, qui sont analysés en anatomopathologie pour déterminer si le cancer s'est étendu aux ganglions.

Q: What is the difference between pelvic and para-aortic lymphadenectomy?

Lymphadenectomy pelvien retire les ganglions du bassin (autour des vaisseaux iliaques). Lymphadenectomy lombo-aortique retire les ganglions plus haut, autour de l'aorte abdominale et de la veine cave inférieure, jusqu'à la veine rénale gauche. Les deux sont souvent associés dans les cancers ovariens et les cancers gynécologiques avancés, car le drainage lymphatique remonte du pelvis vers la région lombo-aortique.

Q: Lymphadenectomy est-il toujours nécessaire pour le cancer de l'ovaire ?

Oui, dans la grande majorité des cas. La stadification ganglionnaire est essentielle pour le cancer de l'ovaire, car elle conditionne le traitement adjuvant. Une exception : si le scanner pré-opératoire ne montre pas de ganglion suspect et que la cytoréduction est complète sans résidu, certaines équipes discutent d'a lymphadenectomy limité (étude LION 2019). En France, les recommandations Saint-Paul de Vence 2024-2025 maintiennent lymphadenectomy systématique dans la majorité des situations.

Summary · 1 minute read

Pelvic and para-aortic lymphadenectomy: key takeaways

→Definition. Lymphadenectomy is the surgical removal of lymph nodes from a given region. Pelvic lymphadenectomy involves the pelvis, para-aortic lymphadenectomy involves the region around the abdominal aorta. This procedure is always associated with the main procedure on the affected organ by the cancer (removal of the uterus, ovaries, etc.) — it is never performed alone.
→Aim. To determine if cancer has spread to the lymph nodes, which allows post-operative treatment to be adjusted (chemotherapy, radiotherapy). Lymph node analysis complements imaging, which only detects nodes larger than 1 cm.
→A now targeted indication. Selon les recommandations Saint-Paul de Vence 2025, lymphadenectomy is no longer systematic in ovarian cancer. It is reserved for situations where suspicious nodes are identified on imaging or during surgery.
→Surgical approach. The operation can be performed by laparoscopy, Da Vinci robot, or laparotomy. The choice depends on the type of cancer and the extent of surgery.
→Pour le cancer de l'ovaire. The procedure is part of a broader surgery called cytoreduction, whose objective is to remove all visible disease. Lymphadenectomy is performed only on suspicious nodes.
→Recovery. Hospital stay of 3 to 7 days depending on surgical approach. Recovery of 4 to 8 weeks. The main long-term complication is leg lymphoedema (10 to 20% of cases).

Comprendre

Why lymph node removal ?

The aim of lymphadenectomy is not systematic removal without purpose. It is about precisely determining the extent of the disease in order to adapt the therapeutic strategy. In certain situations, particularly in advanced ovarian cancer, lymphadenectomy is part of complete cytoreductive surgery.

A precise anatomical pathway. The genital organs — uterus, cervix, ovaries — are drained by a network of lymphatic channels leading to lymph nodes located in the pelvis, then higher around the abdominal aorta. When cancer spreads through the lymphatic system, it follows this path. For ovarian cancers, drainage may reach the para-aortic region directly without passing through the pelvis — hence the need, when lymphadenectomy is indicated, to explore both regions.

L'imagerie a ses limites. CT scan remains the reference examination to assess potential nodal involvement before surgery. But it only detects nodes larger than 1 cm. Micrometastases may be present in normal-sized nodes, undetectable on imaging. This is why, when imaging shows suspicious nodes or in case of doubt during surgery, lymphadenectomy provides a reliable diagnosis.

An important evolution in 2025. The Saint-Paul de Vence 2025 guidelines have evolved the role of lymphadenectomy in ovarian cancer. Based on LION and CARACO trials, systematic lymphadenectomy is no longer recommended in the absence of suspicious nodes on imaging or during surgery. Lymphadenectomy is now performed only on suspicious nodes, which reduces morbidity without compromising patient outcomes.

Indications cliniques

Indications par type de cancer

The indications for lymphadenectomy have evolved recently. The guidelines Saint-Paul de Vence 2025 have modified the role of this procedure, particularly for ovarian cancer. Current indications are precise and take into account the cancer type, preoperative imaging, and intraoperative findings.

Ovarian cancer →

A now targeted indication. According to the Saint-Paul de Vence 2025 guidelines, lymphadenectomy is no longer systematic. It is performed only when suspicious lymph nodes are identified on preoperative imaging or during surgery.

Associated procedure. Lymphadenectomy is part of a broader surgery called cytoreduction. The main procedure consists of removing all visible disease: removal of the ovaries, uterus, omentum, and any suspicious abdominal or pelvic lesion.

→ Learn more sur le cancer de l'ovaire

Cervical cancer →

Early stages. For small tumours, today we prefer the pelvic sentinel node, which avoids standard lymphadenectomy and its complications.

More advanced forms. Treatment relies mainly on chemoradiotherapy combined with brachytherapy. A para-aortic lymphadenectomy may be offered as an option in certain situations, to clarify the extent of disease before radiotherapy.

→ Learn more about cervical cancer

Uterine cancer →

Early stages. Le pelvic sentinel node has replaced standard lymphadenectomy, including for some higher-risk forms, according to the 2024-2025 guidelines.

Advanced stages. In advanced disease or when suspicious nodes are discovered intraoperatively, targeted lymph node removal can be performed. The main procedure remains removal of the uterus, ovaries and omentum, followed by adjuvant treatment (chemotherapy, radiotherapy, immunotherapy).

→ Learn more about uterine cancer

Cancer des trompes de Fallope →

Une prise en charge proche de celle de l'ovaire. Tubal cancers are treated like ovarian cancers and follow the same guidelines.

Approche. Complete cytoreductive surgery, with lymphadenectomy only when suspicious nodes are present on imaging or during surgery.

→ Voir la page cancer de l'ovaire

Surgical technique

Procedure overview

Lymphadenectomy is a precise surgical procedure that requires perfect knowledge of the anatomical structures of the abdomen and pelvis. Several surgical approaches are possible depending on the context.

A procedure always associatedPelvic and para-aortic lymphadenectomy is never performed alone. It is an integral part of the surgery for the cancer concerned — cytoreductive surgery for ovarian cancer (with removal of ovaries, uterus and omentum), hysterectomy for endometrial cancer, or staging procedure before chemoradiotherapy for certain cervical cancers. It is performed during the same operation, under the same anaesthesia. Depending on the cancer concerned: ovarian cancer · cervical cancer · uterine cancer.

1

Choice of surgical approach

Laparoscopic or robotic approach when the operation is a targeted staging lymphadenectomy. Laparotomic approach (vertical midline abdominal incision) for major surgery for advanced ovarian cancer requiring complete cytoreduction.

2

Lymphadenectomy pelvien

Systematic removal of nodes from the external iliac chains (along the external iliac artery and vein), internal iliac (around the hypogastric artery), obturator (in the obturator fossa) and common iliac. The dissection extends from the bifurcation of the aorta down to the inguinal ligament.

3

Lymphadenectomy lombo-aortique

Excision of nodes around the abdominal aorta and inferior vena cava: left lateral aortic, inter-aortocaval, right lateral caval, precaval. Dissection extends from the aortic bifurcation up to the renal vessels (or higher in some cases).

4

Geste oncologique principal

Lymphadenectomy is combined with the main surgical procedure: hysterectomy with bilateral salpingo-oophorectomy for endometrial cancers, radical hysterectomy for some cervical cancers, and complete cytoreductive surgery for ovarian cancer. The choice depends on the disease type and stage.

5

Drainage et fermeture

Placement of one or more Redon drains in the pelvis to evacuate fluids. Closure by planes in laparoscopy (trocar sites) or by anatomical planes in laparotomy. Sterile dressings.

6

Analyse anatomopathologique

Each removed node is individually analysed by the pathologist. The final result is available within 7 to 14 days and discussed at a multidisciplinary team meeting (MDT) to decide on adjuvant treatments if necessary.

Recovery

Post-operative recovery

Post-operative course depends on the surgical approach (laparoscopy, robotic, laparotomy) and on the extent of the procedure performed.

Jour 0 — Jour de l'intervention

Recovery in post-anaesthesia care unit or intensive care unit depending on the extent of surgery. Multimodal analgesia. Systematic preventive anticoagulation. Urinary catheter typically removed on day 2 or 3.

Days 1 to 3

Gradual resumption of diet. Out of bed by day 1, walking around the room. Monitoring of drains, bowel transit and vital signs. Urinary catheter removal once mobilisation is good.

Days 4 to 7

Discharge between day 3 and day 7 depending on the surgical approach. Laparoscopy: 3 to 4 days. Laparotomy: 5 to 7 days. Extended preventive anticoagulation at home for 4 weeks.

3 to 4 weeks

Resumption of daily activities. No lifting over 5 kg. No bathing, showering allowed. Gradual resumption of walking and stationary cycling.

6 to 8 weeks

Return to work depending on the nature of the professional activity. For physically demanding jobs, plan for 8 to 12 weeks. Gradual resumption of sport activity. Convalescence is longer than after a minor procedure.

Surveillance post-op

Post-operative consultation scheduled between 4 and 6 weeks: clinical examination, delivery of pathology results and adjuvant treatment plan (chemotherapy, radiotherapy depending on the MDT decision). Then regular oncological follow-up at 3, 6, 12 months.

Risques et complications

Pelvic and para-aortic lymphadenectomy is a major surgical procedure with several specific risks. All are detailed during pre-operative consultation.

Vascular and ureteric injuries

Ureteric injury: 1 to 3% (intraoperative repair). Iliac vessel or aortic injury: less than 1%. Vena cava injury: major complication, managed immediately by suture.

Saignement

Significant intraoperative bleeding requiring transfusion: 3 to 5%. More common in laparotomy than in laparoscopy. Rare post-operative haemorrhage, possibly requiring surgical revision.

Lymphoceles

Pelvic lymphocele: 5 to 10%. Para-aortic lymphocele: 3 to 5%. Most are asymptomatic with spontaneous resolution. Symptomatic lymphoceles may require ultrasound or CT-guided percutaneous drainage.

Leg lymphoedema

Significant risk after pelvic lymphadenectomy: 10 to 20%. Onset may be delayed (months or years after the procedure). Management combines manual lymphatic drainage and compression stockings.

Complications thrombo-emboliques

Lower-limb venous thrombosis: 1 to 3%. Pulmonary embolism: less than 1%. The risk is limited by systematic preventive anticoagulation prescribed for 4 weeks after oncological surgery.

Complications digestives

Intraoperative bowel injury: 1 to 2%. Post-operative ileus (transient delay of bowel transit): 5%. Late bowel obstruction on adhesions: rare, at distance from the procedure.

Comparison

Lymphadenectomy pelvien vs para-aortic lymphadenectomy

The two anatomical territories are distinct, with specific indications, extents and risk profiles.

Criterion	Lymphadenectomy pelvien	Lymphadenectomy lombo-aortique
Territoire anatomique	Pelvis (iliac chains)	Around aorta and vena cava
Lymph nodes removed	15 to 25	10 to 20
Upper limit	Bifurcation aortique	Left renal vein
Main indications	Cervix IB2+, endometrium, ovary	Ovary systematic, high-risk endometrium
Ureteral injury risk	1 to 3%	< 1%
Risque vasculaire	Vaisseaux iliaques (faible)	Aorte, veine cave (rare mais grave)
Lymphocele	5 to 10%	3 to 5%
Voie d'abord	Cœlio / robot / laparotomie	Extraperitoneal laparoscopy or laparotomy

For early stages of cervical and endometrial cancer, see the dedicated page on pelvic sentinel node biopsy, an alternative technique that avoids lymphadenectomy for eligible patients.

References & sources scientifiques

Scientific references

Harter P, Sehouli J, Lorusso D, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms (LION). N Engl J Med. 2019;380(9):822-832. PMID 30811909.
Querleu D, Planchamp F, Chiva L, et al. European Society of Gynaecological Oncology (ESGO) guidelines for ovarian cancer surgery. Int J Gynecol Cancer. 2017;27(7):1534-1542. PMID 28604444.
Concin N, Matias-Guiu X, Vergote I, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12-39. PMID 33397713.
Cibula D, Pötter R, Planchamp F, et al. The ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer. Int J Gynecol Cancer. 2018;28(4):641-655. PMID 29688967.
du Bois A, Reuss A, Pujade-Lauraine E, et al. Role of surgical outcome as prognostic factor in advanced epithelial ovarian cancer. Cancer. 2009;115(6):1234-1244. PMID 19189349.
Bourgin C, Gillot D, Vidal F, et al. Clinical practice guidelines Nice/Saint-Paul-de-Vence 2022-2023: management of localised uterine cancer. Bull Cancer. 2023;110(6S):6S20-6S33. PMID 37573036.
Clinical practice guidelines Nice/Saint-Paul-de-Vence 2024-2025: management of high-grade epithelial ovarian cancer. Bull Cancer. 2026. ScienceDirect.
Clinical practice guidelines Nice/Saint-Paul-de-Vence 2024-2025: management of localised cervical cancer. Bull Cancer. 2026. ScienceDirect.
Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer (CONSORT). J Natl Cancer Inst. 2005;97(8):560-566. PMID 15840878.
Querleu D, Morrow CP. Classification of radical hysterectomy. Lancet Oncol. 2008;9(3):297-303. PMID 18308255.
Institut National du Cancer. Gynaecological cancers — Management guidelines. INCa, 2024. Available at e-cancer.fr.

This page is for informational purposes and does not replace individualised medical consultation. Page authored and medically reviewed by Dr Jérémie Zeitoun. Last updated: 8 May 2026.

Frequently asked questions

Frequently asked questions sur le pelvic lymphadenectomy et lombo-aortique

The most frequently asked questions by patients, covering the different steps of care. Any additional question can be answered in pre-operative consultation.

Qu'est-ce que lymphadenectomy pelvien et lombo-aortique exactement ?▾

It is the surgical removal of lymph nodes located in the pelvis (external iliac, internal iliac, obturator chains) and those around the abdominal aorta and inferior vena cava (para-aortic chains). The aim is to determine the precise extent of the disease and adapt treatment.

For which cancers is lymphadenectomy indicated?▾

Lymphadenectomy is indicated for advanced gynaecological cancers when suspicious nodes are identified on imaging or intraoperatively. For ovarian cancer, the Saint-Paul de Vence 2025 guidelines have evolved: it is no longer systematic in the absence of suspicious nodes (LION and CARACO trials).

Why remove lymph nodes that appear healthy?▾

Imaging (CT, MRI, PET-scan) only detects nodes larger than 1 cm. However, micrometastases may be present in normal-sized nodes. Lymphadenectomy, when indicated, allows pathological analysis of all sampled nodes to detect such microscopic involvement.

What is the difference between pelvic and para-aortic lymphadenectomy?▾

Pelvic lymphadenectomy targets pelvic nodes (chains around the iliac vessels). Para-aortic lymphadenectomy targets nodes higher up, around the abdominal aorta and inferior vena cava. Depending on the cancer and stage, both can be performed in the same procedure or only one of them.

How does the procedure take place?▾

The procedure is performed under general anaesthesia, by laparoscopy, robotic approach (Da Vinci) or laparotomy depending on the clinical context. Laparotomy remains the reference for advanced ovarian cancers with peritoneal carcinomatosis, where complete abdominal exposure is required. For more targeted procedures on lymph nodes, the laparoscopic or robotic approach is preferred. The operating time varies from 2 to 5 hours depending on the extent of the procedure.

What is the length of hospital stay?▾

Hospital stay of 3 to 5 days after laparoscopy or robotic approach alone, and 5 to 7 days after laparotomy or complete cytoreductive surgery. Recovery is longer than after a sentinel node biopsy alone, particularly because of the systematic preventive anticoagulation continued at home for 4 weeks.

What are the risks of lymphadenectomy?▾

Operative risks include: ureteric injury (1 to 3%), vascular injury (iliac vessels or aorta, less than 1%), bowel injury (1 to 2%), bleeding requiring transfusion (3 to 5%), pelvic lymphocele (10 to 20%), leg lymphoedema (10 to 20%), thromboembolism (1 to 3%). All risks are detailed during pre-operative consultation.

Is lymphadenectomy still necessary for ovarian cancer?▾

No, lymphadenectomy is no longer systematic for ovarian cancer. Saint-Paul de Vence 2025 guidelines have evolved this practice, based notably on the LION trial (NEJM 2019) showing no survival benefit when nodes appear non-suspicious. It is now reserved for situations where suspicious nodes are identified.

Can lymphadenectomy be avoided with sentinel node biopsy?▾

For early stages of cervical and endometrial cancer, the pelvic sentinel node has replaced lymphadenectomy according to the Saint-Paul-de-Vence 2024-2025 guidelines. For ovarian cancer, the sentinel node is not a validated option — but lymphadenectomy is no longer systematic either since 2025. For more advanced cervical cancers, the main treatment today is chemoradiotherapy combined with brachytherapy; a para-aortic lymphadenectomy may be discussed as an option in certain situations. Voir la dedicated page on pelvic sentinel node biopsy for precise indications.

Why consult Dr Zeitoun for this procedure?▾

Dr Zeitoun is a gynaecological and breast surgical oncologist, trained at Institut Gustave Roussy (European reference centre in gynaecological oncology) and at Institut Curie. Il pratique pelvic and para-aortic lymphadenectomy via laparoscopic, robotic and laparotomy approaches, as well as complete cytoreduction techniques for ovarian cancer. All therapeutic decisions are validated in multidisciplinary tumour boards (MDT). Clinic in Paris 8th district (241 rue du Faubourg Saint-Honoré), operating theatre at Clinique Hartmann (Neuilly-sur-Seine).

Based on your situation

Pelvic and para-aortic lymphadenectomy is part of the comprehensive management of a gynaecological cancer. To better understand your situation, please refer to the dedicated cancer page.

Alternative technique

Sentinel node pelvien →

Vue d'ensemble

All gynaecological cancers →

Consultation et second avis

Échanger sur votre situation

For a first or second opinion regarding the management of an advanced gynaecological cancer or ovarian cancer, you can book an appointment with Dr Zeitoun. Teleconsultation is available for international patients.

Book an appointment +33 1 58 05 11 24

241 rue du Faubourg Saint-Honoré, 75008 Paris · Clinique Hartmann, 92200 Neuilly-sur-Seine

Lymphadenectomy pelvien et lombo-aortique Dr Jérémie Zeitoun · Advanced gynaecological and ovarian cancers

Pelvic and para-aortic lymphadenectomy: key takeaways

Why lymph node removal ?

Indications par type de cancer

Ovarian cancer →

Cervical cancer →

Uterine cancer →

Cancer des trompes de Fallope →

Procedure overview

Choice of surgical approach

Lymphadenectomy pelvien

Lymphadenectomy lombo-aortique

Geste oncologique principal

Drainage et fermeture

Analyse anatomopathologique

Post-operative recovery

Risques et complications

Vascular and ureteric injuries

Saignement

Lymphoceles

Leg lymphoedema

Complications thrombo-emboliques

Complications digestives

Lymphadenectomy pelvien vs para-aortic lymphadenectomy

Scientific references

Frequently asked questions sur le pelvic lymphadenectomy et lombo-aortique

Based on your situation

Échanger sur votre situation

Transparent pricing