Defining Retroperitoneal Lymph Node Dissection: A Systematic Review of Anatomical Landmarks and TemplateTerminology

Published descriptions of retroperitoneal lymph node dissection (RPLND) vary considerably in the anatomical landmarks used to define dissection boundaries and in the terminology used to describe surgical templates. Although consensus guidelines such as the National Comprehensive Cancer Network recommendations exist for testicular cancer, the consistency with which anatomical borders are described across the urological, gynecological, and colorectal literature more broadly remains unclear.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and a prospectively registered protocol (PROSPERO CRD420251241950). The search strategy was designed to capture gynecological, colorectal, and urological literature reporting RPLND, and PubMed and Scopus were searched from inception to December 16, 2025. Two reviewers independently screened records, assessed full texts, and extracted data on study characteristics, anatomical borders, template nomenclature, and selected perioperative and oncological outcomes.

Eighteen studies met inclusion criteria. Despite a search strategy designed to capture gynecological, colorectal, and urological literature, the available evidence was exclusively urological in origin, comprising 16 studies of testicular germ cell tumors, one study of renal cell carcinoma, and one study of prostate cancer; no eligible gynecological or colorectal studies were identified. Substantial heterogeneity was identified across all reported template dimensions despite the existence of National Comprehensive Cancer Network consensus recommendations for testicular cancer. The ureter was the most consistently used lateral boundary, whereas cranial, caudal, posterior, and interaortocaval limits varied widely between studies and across tumor types. The cranial border was the most commonly defined at the renal artery or renal vessels, but some series used the renal vein, renal hilum, or more restricted landmarks. Reporting of posterior boundaries and interaortocaval extent was frequently incomplete.

Contemporary literature demonstrates marked inconsistency and in how RPLND boundaries are defined and reported across urological malignancies, even where consensus guidelines exist. Furthermore, there is a marked gap in RPLND reporting in gynecological and colorectal literature. Standardized, tumor-specific reporting of template borders is needed across the malignancies in which RPLND is performed, to improve comparison of outcomes, clarify the relationship between extent of dissection and morbidity, and support future consensus development grounded in patterns of nodal disease distribution.