Lymphadenectomy





Definition

Lymphadenectomy, also called lymph node dissection, is a surgical procedure in which lymph glands are removed from the body and examined for the presence of cancerous cells. A limited or modified lymphadenectomy removes only some of the lymph nodes in the area around a tumor; a total or radical lymphadenectomy removes all of the lymph nodes in the area.


Purpose

The lymphatic system is responsible for returning excess fluid from body tissues to the circulatory system and for defending against foreign or harmful agents such as bacteria, viruses, or cancerous cells. The major components of the lymphatic system are lymph capillaries, lymph vessels, and lymph nodes. Lymph is a clear fluid found in tissues that originates from the circulatory system. Lymph capillaries are tiny vessels that carry excess lymph to larger lymph vessels; these in turn empty to the circulatory system. Lymph nodes are small, oval- or bean-shaped masses found throughout the lymphatic system that act as filters against foreign materials. They tend to group in clusters in such areas as the neck (cervical lymph nodes), under the arm (axillary lymph nodes), the pelvis (iliac lymph nodes), and the groin (inguinal lymph nodes).

The lymphatic system plays an important role in the spread of cancerous cells throughout the body. Cancer cells can break away from their primary site of growth and travel through the bloodstream or lymphatic system to other sites in body. They may then begin growing at these distant sites or in the lymph nodes themselves; this process is called metastasis. Removal of the lymph nodes, then, is a way that doctors can determine if a cancer has begun to metastasize. Lymphadenectomy may also be pursued as a cancer treatment to help prevent further spread of abnormal cells.


Demographics

The American Cancer Society estimates that approximately 1 million cases of cancer are diagnosed each year. Seventy-seven percent of cancers are diagnosed in men and women over the age of 55, although cancer may affect individuals of any age. Men are more often affected than women; during his lifetime, one in two men will be diagnosed with cancer, compared to one in three women. Cancer affects people of all races and ethnic backgrounds, although cancer type does vary somewhat depending upon these factors.


Description

Although the specific surgical procedure may differ according to which lymph nodes are to be removed, some steps are common among all lymphadenectomies. General anesthesia is usually administered for the duration of surgery; this ensures that the patient remain unconscious and relaxed, and awaken with no memory of the procedure.

First, an incision is made into the skin and through the subcutaneous layers in the area where the lymph nodes are to be removed. The lymph nodes are identified and isolated. They are then carefully taken out from surrounding tissues (that is, muscles, blood vessels, and nerves). In the case of axillary node dissection, the pad of fat under the skin of the armpit is removed; generally, about 10 to 20 lymph nodes are embedded in the fat and separately removed. The incision is sutured (stitched) closed with a drain left in place to remove excess fluid from the surgical site.

Alternatively, laparoscopy may be used as a less invasive method of removing lymph nodes. The laparoscope is a thin, lighted tube that is inserted into the abdominal cavity through a small incision. Images taken by the laparoscope may be seen on a video monitor connected to the scope. Certain lymph nodes, such as the pelvic and aortic lymph nodes, may be removed using this technology.

Diagnosis/Preparation

Lymph nodes may become swollen or enlarged as result of invasion by cancer cells. Swollen lymph nodes may be palpated (felt) during a physical exam. Before lymph nodes are removed, a small amount of tissue is usually removed. A biopsy will be performed on it to check for the presence of abnormal cells.

The patient will be asked to stop taking aspirin or aspirin-containing drugs for a period of time prior to surgery, as these can interfere with the blood's ability to clot. Such drugs may include prescription blood thinners (for example, Coumadin—generically known as warfarin and heparin). However, patients should discuss their medications with regard to their upcoming surgery with their doctors, and not make any adjustments or prescription changes on their own. No food or drink after midnight the night before surgery will be allowed.


Aftercare

Directly following surgery, the patient will be taken to the recovery room for constant monitoring and to recover from the effects of anesthesia. The patient may then be transferred to a regular room. If axillary nodes have been removed, the patient's arm will be elevated to help prevent postsurgical swelling. Likewise, the legs will be elevated if an inguinal lymphadenectomy had been performed. A drain placed during surgery to remove excess fluids from the surgical site will remain until the amount of fluid collected in the drain decreases significantly. The patient will generally remain in the hospital for one day.

Specific steps should be taken to minimize the risk of developing lymphedema, a condition in which excess fluid is not properly drained from body tissues, resulting in swelling. This swelling can sometimes become severe enough to interfere with daily activity. Common sites where lymphedema can develop are the arm or leg. Prior to being discharged, the patient will receive the following instructions for care of areas of the body that may be affected by lymph node removal:

  • All cuts to the area should be properly cleaned, treated with an antibiotic ointment, and covered with a bandage.
  • Heavy lifting should be avoided; bags should be carried on the unaffected arm.
  • Tight jewelry and clothing with tight elastic bands should be avoided.
  • Injections, blood draws, and blood pressure measurements should be done on the unaffected arm.
  • Sunblock should be worn on the affected area to minimize the risk of sunburn.
  • Steps should be taken to avoid cuts to the skin. For example, an electric razor should be used to shave the affected area; protective gloves should be worn when working with abrasive items.

Risks

Some of the risks associated with lymphadenectomy include excessive bleeding, infection, pain, excessive swelling, vein inflammation (phlebitis), and damage to nerves during surgery. Nerve damage may be temporary or permanent and may result in weakness, numbness, tingling, and/or drooping. Lymphedema is also a risk whenever lymph nodes have been removed; it may occur immediately following surgery or from months to years later.


Normal results

After removed lymph nodes have been examined microscopically for the presence of cancerous cells, they may be labeled node-negative (no presence of cancer cells) or node-positive (presence of cancer cells). These findings are the basis for deciding the next step in cancer treatment, if one is indicated.

Morbidity and mortality rates

The rate of complications following lymphadenectomy depends on the specific lymph nodes being removed. For example, following axillary lymphadenectomy, there is a 10% chance of chronic lymphedema and 20% chance of abnormal skin sensations. The overall rate of complications following inguinal lymphadenectomy is approximately 15%, and 5–7% following pelvic lymphadenectomy.


Alternatives

A technique designed to spare the unnecessary removal of normal lymph nodes is called sentinel node biopsy. When lymph fluid moves out of a region, the sentinel lymph node is the first node it reaches. The theory behind sentinel lymph node biopsy is that if cancer is not present in the sentinel node, it is unlikely to have spread to other nearby nodes. This procedure may allow individuals with early stage cancers to avoid the complications associated with partial or radical removal of lymph nodes if there is little or no chance that cancer has spread to them.


Resources

BOOKS

St. Louis, James D. and Richard L. McCann. "Lymphatic System" (Chapter 65). In Sabiston Textbook of Surgery. Philadelphia: W. B. Saunders Company, 2001.

PERIODICALS

Beneditti-Panici, Pierluigi, et al. "Pelvic and Aortic Lymphadenectomy." Surgical Clinics of North America 81, no. 4 (August 1, 2001): 841-58.

Colberg, John W. "Inguinal Lymph Node Dissection for Penile Carcinoma: Modified Verses Radical Lymphadenectomy." Infections in Urology 13, no. 5 (2000): 115-20.

Gervasoni, James E., et al. "Biological and Clinical Significance of Lymphadenectomy." Surgical Clinics of North America 80, no. 6 (December 1, 2000): 1631-73.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org .

Society of Surgical Oncology. 85 W. Algonquin Rd., Suite 550, Arlington Heights, IL 60005. (847) 427-1400. http://www.surgonc.org .

OTHER

"All About Cancer: Detailed Guide." American Cancer Society. 2003 [cited April 9, 2003]. http://www.cancer.org/docroot/CRI/CRI_2_3.asp .

Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Lymphadenectomy is usually performed in a hospital operating room by a surgical oncologist, a medical doctor who specializes in the surgical diagnosis and treatment of cancers.

QUESTIONS TO ASK THE DOCTOR


  • Why is lymphadenectomy recommended?
  • How many lymph nodes will be removed?
  • How long will the procedure take?
  • When will I find out the results?
  • Am I a candidate for sentinel node biopsy?
  • What will happen if the results are positive for cancer?

User Contributions:

Alice Evans
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Oct 3, 2007 @ 12:12 pm
I have been over weight for awhile (years) but all of a sudden I am beginning to notice I have more fat on one side of my body than I have on the other side. What could be causing that? I had a problem with my leg right leg swelling once and every now and then presently and I used a pump for that dondition at that time. Could that problem move into my upper body parts?
Anna Marie Monson
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Jul 22, 2009 @ 7:19 pm
I was operated for Endometrial Cancer in Jan 09. Shortly after the surgery I developed a burning pain and weakness in my right leg. I was aware that lymph nodes had been removed however I never made the connection regarding my leg and the removal of the lymph nodes till now.
Since I have lower back issues (herniated discs) for many years I was told by a neurologist that the leg issues are related to this prior condition. Even though up until the surgery I had never had this severe leg burn or weakness. I have been to therapy for my back and had altered my life style so as to not aggravate it.
Now after reading this article I am convinced that my leg problems are related to the Lymphadenectomy even though I had a stage one B cancer they did remove the lymph nodes.
I am very disapointed that my Oncological Gynecologist did not help me understand what what happening and let me go down a path of confusion trying to find out what to do about my pain in the leg that naturally is not responding to the "lower back therapy" that I have been perscribed.
In general I'd say that the level of care given to me after this cancer surgery has been less than acceptable.

Thank you for having information available it's taken me 5 months of searching for answers to finally find something that explains the pain and weakness in my leg.
Sincerely, Anna Marie Monson
sh
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Sep 26, 2010 @ 9:09 am
A lump was found on my lymph (iliac) and is getting big, and my dr ask me to decide whether an operation is to be taken.
I am on Iressa and dr told me that risk is my leg will get swollen but until a surgery is done, the lump has to be studied and the result has to be determined whether it's malignant or not.
dr told me to decide quickly whether to proceed or not and it may not be feasible if leave it for too long.
Please let me know your view
Thanks very much
nan
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May 28, 2011 @ 8:20 pm
I had an excisional lymph node biopsy, one lymph node removed from my right inguial area. Cancer free, but, now ten days on, though the incision is healing well, thre is an alarming amount of swelling at the site. I mean huge, the size of an ostrich egg, pressure and pain and tingling in the inner thigh. I see the dr. in three days, I have been elevating the leg, resting, wrapping toward the heart from the calf upward to the waist. Appyling heat and cold alternately. What else can I do??
Steve
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May 17, 2012 @ 12:12 pm
After an operation for removsl of penal cance the doctor had a CT scan performed of my pelvic area. The scan showed that I had lumps in the lymph nodes in my groin area - although about a week ago a lump appeared in my left side - groin. After consultation with my doctor he wants to operate and remove the nodes as quickly as possible to prevent cance from spreading. I asked about alternate methods and was advised that chemotherapy was an alternative or possibly a possible procedure in addiiton to the removal of the lymph nodes. I am pondering the options available and need some help from anyone who may have gone through this provedure and had chemotherapy before or after the removal of the lymph nodes. Any recommendations and comments is greatly appreciated. My doctor did indicate the problems I could expect with my leg once the lymph nodes are removed.
kathy
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Jun 27, 2012 @ 3:15 pm
I just had a mass removed from my groin. The CAT scan said the lymph node was swollen but the biopsy said a fatty tumor. The dr. decided to take out the mass. I am waiting for the results of the surgery. It is very swollen today and sore. I am a little nervous as to why it's so swollen. I also found a lump on the other side which they biopsied and said it was a fatty tumor. Nothing makes much sense to me. I don't know what to do right now. The surgeon didn't tell me much. He said that I have a 4 to 6 week recovery time which surprised me. I didn't think it was going to be that bad.
mumamafia
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Aug 23, 2012 @ 5:17 pm
I have just returned home from having lymph nodes fremoved from the left side of groin, tho they couldt take the right side?
im so gald to have read this article as at least i can keeo an eye open for any of the signs mentioned.

i also wish you all a speedy recovery..
mumamafia
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Aug 23, 2012 @ 5:17 pm
I have just returned home from having lymph nodes fremoved from the left side of groin, tho they couldt take the right side?
im so gald to have read this article as at least i can keeo an eye open for any of the signs mentioned.
One thing im puzzled abt .
i read in the Lymphoma booklet and it mentions about having a drip in to drain excess fluid?
i didnt have one when i recovered do you think they may have just used this drain whilst asleep?

i also wish you all a speedy recovery..
karissa
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Aug 28, 2013 @ 8:08 am
i hadba lymphnode removed monday..its.now wendsay and its.not too sore but im very very nasaus. is this normal..called the doc and said its from pain meds but i havnt had one since 530 last night and now its 9 am..

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