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[Lymphatic system](https://durgical.com/en/anatomy/system/lymphatic-system/) · [Pelvis](https://durgical.com/en/anatomy/region/pelvis/)

# Sacral nodes

The sacral nodes lie on the front of the sacrum, behind the rectum; they filter lymph from the back of the [cervix](https://durgical.com/en/anatomy/cervix-of-uterus/) and from the rectum.

Official name: Lateral sacral nodes

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## What it is

Lymph nodes in front of the sacrum.

## What it does

Drain the back of the cervix, the rectum and the uterosacral ligaments.

## Key points

- They lie in the presacral tissue behind the rectum, along the median and lateral sacral vessels
- Cervical cancer can spread to them along the uterosacral ligaments, one reason those ligaments are resected in radical hysterectomy
- They also drain the rectum and posterior pelvic wall and, in men, part of the [prostate](https://durgical.com/en/anatomy/prostate/)

## Key facts

**Where**
In front of the sacrum along the lateral and median sacral vessels

**Drains**
Posterior cervix and [vagina](https://durgical.com/en/anatomy/vagina/), rectum, uterosacral ligaments

**Into**
Internal and common iliac nodes

## Relations

**Behind**
[Sacrum](https://durgical.com/en/anatomy/sacrum/) and the anterior sacral foramina with the sacral nerve roots

**In front**
[Rectum](https://durgical.com/en/anatomy/rectum/) and mesorectum

**Lateral**
Internal iliac vessels and nodes

**Above**
Sacral promontory, above which their lymph continues to the [common iliac nodes](https://durgical.com/en/anatomy/common-iliac-nodes/)

## How to find it

They cannot be felt reliably. On MRI or CT they are sought in the presacral space between the sacrum and the mesorectum; in surgery they are reached by lifting the rectum off the sacrum, where the presacral veins call for care.

## On imaging

MRI and PET-CT judge presacral nodes; a presacral mass has many other causes (developmental cysts, nerve sheath tumours, chordoma), so the whole space is reviewed.

## Clinical notes

- Presacral nodes are included in the pelvic nodal fields of radiotherapy for cervical cancer
- Disease recurring in the presacral space is hard to remove because it lies against the sacrum and the sacral nerves
- When pelvic nodes are irradiated for high-risk prostate cancer, the presacral nodes over the upper sacrum are usually included in the target
- An enlarged presacral node on imaging must be told apart from other masses of this space, such as a developmental cyst, a nerve sheath tumour or a chordoma

## Test yourself

Think of the answer, then tap the question to see it.

## Where do the sacral nodes lie?

In the presacral tissue behind the rectum, along the median and lateral sacral vessels.

## Why are the uterosacral ligaments resected in radical hysterectomy, in relation to the sacral nodes?

Cervical cancer can spread along the uterosacral ligaments to the sacral nodes.

## Why is disease recurring in the presacral space hard to remove?

It lies against the sacrum and the sacral nerves.

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Educational information, not medical advice. For any symptom, see a health professional.

## Its names

**Official Latin (TA2)**
nodi sacrales laterales TA2 5338

**Official Spanish (DeCS)**
Nódulos linfáticos sacros DeCS D008198

**English (TA2)**
Lateral sacral nodes

**Also called**
nodi sacrales

Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=8375); [Anatomy, Abdomen and Pelvis: Lymphatic Drainage](https://www.ncbi.nlm.nih.gov/books/NBK557720/).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/anatomy/lateral-sacral-nodes/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/lateral-sacral-nodes/