Renal lymphatic drainage and thoracic duct connections : Implications for cancer spread

Studies on renal lymph drainage havegenerally described lymph nodes withoutfurther investigation of the lymph vessels.Our purpose was to revisit this organ to studythe vessel drainage pattern. This investigationwas performed on 16 refrigerated adultcadavers. After both kidneys were injectedwith a blue modified Gerota mass, lymphvessels were dissected until their termination.From the right kidneys (n=13), lymphatics(n=8) traveling on the anterior aspect of theinferior vena cava were dissected, reachinginteraortocaval and more distant nodes, aortabifurcation (n=1) and left lateroaortic (n=1);posterior lymphatics were observed in allsubjects, uniformly connecting to the thoracicduct, either after crossing nodes (n=8) ordirectly (n=5). From the left kidneys(n=13),anterior efferents (n=16) were dissected,reaching left lateroaortic and also celiac (n=4)and iliac (n=1) nodes; posterior lymphaticswere also demonstrated, always connecting tothe thoracic duct (3 directly). Renallymphatics have been found to reach verydistant nodes as well as always connecting tothe origin of the thoracic duct. This featuresuggests an important role in both theformation of the thoracic duct and in thespread of renal cancer.