Lymphadenectomy

November 22, 2024

This page was reviewed under our medical and editorial policy by Laleh Melstrom, M.D., M.S., associate professor of surgery and immuno-oncology, Division of Surgical Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

A lymphadenectomy is a surgery to remove lymph nodes, which are then examined for the presence of cancer cells. It is also called lymph node dissection or lymph node removal surgery.

It helps doctors treat cancer and learn more about how much a cancer has spread, helping to more clearly define the stage of cancer.

Why Is Lymph Node Removal Performed?

Lymph nodes are part of the infection-fighting lymphatic system. They are small, bean-like organs that circulate lymphatic fluid and white blood cells throughout the body to combat disease.

Lymph node removal is usually performed when someone already has a cancer diagnosis and the doctor needs to know if it has spread (metastasized).

Lymph nodes close to tumors are often the first place cancer cells spread, which then gives them access to the rest of the body through the network of lymph nodes throughout the body.

Removing affected lymph nodes helps to remove cancer cells from the body, and it may help to lower the chance of further spread.

Lymph Node Dissection Types

The two main types of lymph node dissection are regional lymphadenectomy and radical lymphadenectomy. The health care team gathers information about the type of cancer cells and how much cancer spread is in the lymph nodes in order to recommend a surgical approach.

For some cancers, the surgeon examines one of the nearby lymph nodes most likely to have cancer first (sentinel node biopsy) before deciding which type of surgery to perform.

Lymph nodes may be removed at different points in cancer treatment. Sometimes, it is part of a larger surgery during diagnosis, and sometimes nodes are removed later in treatment to see if the therapy worked or the cancer has spread.

Regional Lymphadenectomy

A regional lymphadenectomy involves the removal of some of the lymph nodes close to the tumor.

Radical Lymphadenectomy

A radical lymphadenectomy removes most or all of the lymph nodes in the tumor region.

Where Does Lymph Node Removal Occur?

Lymph nodes are usually removed from the area closest to the cancer. The most common areas are listed below.

Axillary lymph node dissection (ALND): Lymph nodes are removed from the armpit on the affected side for breast cancer.

Retroperitoneal lymph node dissection (RPLND): Retroperitoneal lymph nodes, which are found at the back of the abdomen, are removed in testicular and ovarian cancer.

Pelvic lymph node dissection (PLND): Lymph nodes from the lower abdomen, also called iliac lymph nodes, are removed in penile, bladder, prostate, cervical and colorectal cancer.

Cervical lymph node removal: These lymph nodes may be removed from the neck in thyroid or other head and neck cancers. The procedure is also called a neck dissection and may involve removing a few lymph nodes (partial); most of the lymph nodes on one side, along with some nerves, muscle and tissue between the jawbone and collarbone (modified radical); or all the lymph nodes as well as more of the nerves, muscle and tissue (radical).

Mediastinal lymph node removal: These nodes, located in the center of the chest cavity, may become affected when lung cancer or lymphoma spreads.

Inguinal node removal: Lymph nodes, located in the groin, are often removed in penile, vulvar or anal cancers.

What Happens During Lymphadenectomy Surgery?

Lymphadenectomy surgery is done in slightly different ways, depending on where the lymph nodes are located and whether the surgeon is removing some or all of the lymph nodes.

Open surgery: During open surgery, the surgeon makes one incision (cut) on the skin to access the lymph node area.

Laparoscopic surgery: During laparoscopic surgery, several very small cuts on the skin allow the surgeon to insert a small lighted camera (laparoscope) into one opening and specially made instruments into the others to remove the lymph nodes. Some surgeons may use robotic arms to perform laparoscopic surgery (robotic surgery).

During the procedure, the patient is given a general anesthetic and is asleep during surgery. After removing the lymph nodes, a soft hollow tube (drain) may be placed in the opening, secured and attached to a drainage collector. This tube stops fluids from building up in the tissues around the surgery site, and it is usually left in until the fluids stop draining, which may take a few weeks.

The incisions are closed with sutures (stitches) or special staples. Finally, they are covered with a thick dressing to control fluid buildup or bleeding under the skin.

Lymphadenectomy Recovery

The recovery process after lymphadenectomy depends on the location of the surgery, the approach used and the patient’s overall health.

Some patients go home the same day, while others may need to stay in the hospital for a short period.

Patients whose inguinal nodes are removed are more prone to leg swelling, so the surgeon may recommend wearing compression stockings and keeping legs elevated above the level of their heart.

Patients will also need to care for their surgical skin wound as directed, keeping it clean and dry. Patients usually return within two to three weeks to have their stitches/staples and drain removed.

The health care team may discuss activity limitations and returning to work before going home.

In general, laparoscopic and robotic surgeries are more precise, so there is less damage to the surrounding tissue and less blood loss, leading to a faster recovery time.

Lymph Node Removal Side Effects

Any type of surgery may have side effects, depending on where the surgery is performed and how many lymph nodes and tissues are removed. Some side effects may start right away, while others may take weeks or months to develop. The most common side effects may include:

• Pain at the surgery site, which is normal for the first few days
• Numbness or tingling caused by swelling, which squeezes the nerves
• Wound infection that causes redness, pain and sometimes discharge (which is why the wound must be kept clean and dry)
• Clots, which may happen if blood pools in blood vessels, especially if the patient is not moving around much (clots that break break away may damage the brain, heart or lungs)

Lymph node removal has a few additional side effects, especially when several lymph nodes are removed, while the body figures out a new way to drain the lymph fluid.

Lymphedema is when lymphatic fluids pool in fatty tissues instead of circulating. It is most commonly seen in the arms and legs, but it may affect the neck, chest or abdomen. Sometimes it will settle down, and other times it is permanent. Physiotherapy and lymphedema clinics may help.

Some side effects are associated with the lymph node location, such as the following.

Axillary lymph node dissection is associated with:

• Higher chances of developing lymphedema
• Decreased movement of the shoulder and arm
• Axillary web syndrome (AWS), which involves scarring in the connective tissue, forming a rope-like structure that starts in the armpit, but may extend to the elbow, causing pain and restricting movement, and may go away on its own or require physiotherapy

Neck dissection side effects usually involve nerve damage, causing numbness to the ear, weakness when raising the arm or weakness to the lower lip. These effects may be temporary if the nerve is damaged and just needs to heal, although it may take months. If the nerve was removed, the change is usually permanent. In all cases, physiotherapy may help.

Retroperitoneal lymph node dissection does not affect sexual function in men, but sometimes one of the nerves responsible for ejaculation may be injured. This may cause retrograde ejaculation, meaning that the semen goes backward (retrograde) into the bladder instead of into the urethra. This may make it more difficult to father children. However, surgeons have developed a technique called nerve-sparing surgery to decrease the chances of this happening.

Some side effects may be a sign of something serious happening and should not be ignored. Patients should contact their doctor if they are experiencing any of the following symptoms:

• Pain at the wound site is getting worse instead of better, or not improving with pain medication
• Fever or chills
• Breathing difficulties, such as shortness of breath or having trouble taking a breath
• Bleeding at the wound site or anywhere else
• Difficulty urinating, painful urination, or bloody, cloudy or foul-smelling urine
• Unusual pain in the legs, chest or belly
• A severe headache
• Any other symptoms the health care team mentioned