Anatomical considerations in suprahilar lymph node dissection for testicular tumors

To evaluate the usefulness of removing lymph nodes located above the renal vessels in men with nonseminomatous testicular cancer we have: (1) reviewed the anatomy of the testicular lymphatic drainage; (2) analyzed data on 30 suprahilar lymph node dissections, and (3) reviewed 19 CT scans on patients with testicular cancer. Because the primary lymphatic drainage of the testis is not to suprahilar nodes, in the absence of bulky disease these lymph nodes rarely contain metastatic disease. Furthermore, because most suprahilar lymph nodes are located behind the aorta in between the crura of the diaphragm these lymph nodes are difficult, if not impossible, to resect. Thus, in patients without lymph node enlargement, suprahilar extension of routine lymphadenectomies is not recommended.