Lymphadenectomy

Overview

A lymphadenectomy is a surgical procedure aimed at removing and dissecting lymph nodes. 

Lymph nodes are glands found in the lymphatic system, a complex network of vessels, tissues, and organs that spans throughout the body. Primary function of lymph nodes involves filtering lymphatic fluid, known as lymph, and eliminating both damaged and cancerous cells. 

A lymphadenectomy is a procedure conducted to detect any signs of cancer within your lymph nodes.

Reasons for undergoing the procedure

When healthcare providers suggest a lymphadenectomy, it is typically for individuals already diagnosed with cancer. The dissection of lymph nodes in the vicinity of the tumor serves as a method to ascertain whether the cancer has extended beyond the tumor (metastasis). This procedure is an integral part of the cancer staging process, aiding healthcare providers in determining the most suitable treatment strategy.

Lymphadenectomy, also referred to as lymph node dissection, is advised for individuals diagnosed with specific types of cancer prone to metastasizing to lymph nodes. Since the lymphatic system serves as one of the primary routes for cancer spread, examining nearby lymph nodes becomes crucial, as they are often the initial sites of potential spread. By dissecting and analyzing a few nodes, healthcare providers gain insights into the extent of the cancer’s progression within the lymphatic system.

Conditions treated

Lymph node dissection serves a twofold purpose: diagnosis and treatment. When cancer cells are detected in dissected lymph nodes by the surgeon, it confirms the removal of those cancerous cells during the procedure. Identifying cancer in these nodes prompts further investigation by the surgeon, potentially leading to the removal of additional lymph nodes if needed. This removal of affected lymph nodes acts as a preventive measure to stop the potential spread of cancer.

Conditions that commonly benefit from lymphadenectomy include:

• Head and neck cancer
• Thyroid cancer
• Breast cancer
• Lung cancer
• Stomach cancer
• Colorectal cancer
• Melanoma

Types of lymphadenectomy

The primary categories are “regional” and “radical.” A regional (or selective) lymphadenectomy involves the removal of a sample of lymph nodes situated near the tumor. On the other hand, a radical lymphadenectomy (also referred to as complete or total lymphadenectomy) entails the removal of all lymph nodes within that specific region.

At times, surgeons initiate the procedure by dissecting the single lymph node closest to the tumor and examining it for the presence of cancer, known as a sentinel node biopsy. Should this node exhibit signs of cancer, the surgeon may proceed to remove additional nodes for further examination.

Areas where lymph nodes are removed

Clusters of lymph nodes are distributed throughout your body, and a lymphadenectomy specifically targets one of these clusters based on the location of your cancer. Certain cancers follow predictable pathways, often starting with specific lymph node clusters, each identified by a distinct name. Your surgeon will focus on dissecting one, some, or all of these nodes as necessary to screen for cancer.

Examples include:

• Cervical lymphadenectomy: Focuses on the cervical lymph nodes in the neck, typically performed for cancers affecting the head, neck, and thyroid.
• Axillary lymphadenectomy: Targets the axillary lymph nodes located in the armpit, commonly associated with the initial spread of breast cancer or melanoma of the arm.
• Mediastinal lymphadenectomy: Involves the dissection of mediastinal lymph nodes in the central chest cavity. This procedure is relevant for cancers such as lung cancer and lymphoma, which may also spread to the supraclavicular lymph nodes near the collarbone.
• Inguinal lymphadenectomy: Involves the dissection of lymph nodes in the inguinal canal on either side of the groin. This is relevant for cancers such as penile cancer and vulvar cancer. An inguinofemoral lymphadenectomy extends to include the femoral lymph nodes beneath the inguinal canal.
• Retroperitoneal lymphadenectomy: Targets the retroperitoneal lymph nodes in the back of the abdominal cavity, where cancers like testicular cancer and ovarian cancer are prone to spreading.
• Pelvic lymphadenectomy: Addresses the pelvic lymph nodes (iliac lymph nodes) in the upper pelvis, commonly implicated in the spread of bladder cancer, rectal cancer, and prostate cancer.

Lymphadenectomy can be performed at various stages of cancer treatment, serving as an early diagnostic procedure before initiating treatment or as part of a comprehensive operation to remove a tumor. It may also be conducted after completing cancer therapy, such as radiation or chemotherapy, to verify the absence of residual cancer.

Risks

Potential risks associated with lymph node surgery encompass:

• Injury to the nerve.
• Injury to nearby vessels or organs.
• Wound infection.
• Formation of blood clots.

Complication which may occur after the procedure

After the removal of your lymph nodes, potential side effects may include:

• Numbness/stiffness: Damage to a nerve in the area may lead to short–term or longer–term numbness or stiffness. Exercises or physical therapy can assist in managing these effects.
• Fibrosis: Some individuals may develop extensive scar tissue, and in severe cases, fibrosis might impede nearby vessels or muscles, resulting in pain or restricted movement.
• Lymphedema: Permanent fluid retention (edema) can occur in some individuals, characterized by an excess of lymphatic fluid collecting in the tissues. The likelihood of lymphedema increases with the removal of numerous lymph nodes and concurrent chemotherapy or radiation therapy, which can damage the lymphatic system. The severity of lymphedema can vary from mild to severe.
• Seroma: A common short–term side effect involves the accumulation of fluid under the skin at the surgical site. The lymphatic system needs time to redirect the lymph fluid.

Before the procedure

Before proceeding with a lymphadenectomy, your physician usually begins with initial assessments of your lymph nodes. This often includes radiological imaging to observe any swelling or abnormalities. Additionally, they may conduct a fine needle biopsy or a core needle biopsy to detect cancer cells in a single node. If these tests indicate positive results, the possibility of further investigation through a lymphadenectomy is considered.

During the procedure

A lymphadenectomy can be performed through either open surgery or laparoscopic surgery, with some medical centers offering laparoscopic lymphadenectomy with robotic assistance. Laparoscopic and robotic surgery are minimally invasive techniques that enable surgeons to operate through small keyhole incisions. The choice of method depends on the specific procedure and your overall health.

The standalone lymphadenectomy is a minor procedure, typically lasting about an hour in the operating room. General anesthesia will be administered to you during the operation. In open surgery, your surgeon will make a single incision in the targeted area, while in laparoscopic surgery, several small incisions will be used. A camera is inserted through one incision, and the surgeon operates through another.

During the procedure, your surgeon will remove the designated lymph nodes and, at times, some surrounding tissue. These samples will be sent to the lab for dissection and analysis to detect any presence of cancer. Before closing the surgical wound, a tube attached to a pouch, known as a drain, will be placed. This drain helps prevent fluid accumulation in the tissues and typically remains in place for several days to weeks following the operation.

After the procedure

Following a standalone laparoscopic lymphadenectomy, it is probable that you can be discharged on the same day. In the case of open surgery or a more extensive procedure, a hospital stay of one to three days may be necessary. 

Your doctor will provide instructions on how to manage your wound at home. A follow–up appointment, typically scheduled for a week or two later, may be required for the removal of drains or stitches and to discuss the results of your biopsy.

Outcome

The results of your lymphadenectomy offer crucial insights for both you and your doctor concerning the stage and prognosis of your cancer. This information includes precise details about the stage and type of cancer being addressed. If cancer is found in your lymph nodes, there’s a statistically increased risk of cancer recurrence post–treatment. Nevertheless, removing affected lymph nodes remains the most effective approach for eradicating all cancer cells.