Inguinal Lymph Node Dissection

What is inguinal lymph node dissection?

Inguinal lymph node dissection is the surgical removal of lymph nodes from your groin (where your legs meet your lower abdomen). A provider might remove these lymph nodes to check to see if cancer has spread from a nearby part of your body or to stop cancer from spreading.

Other names for this procedure are groin dissection or lymphadenectomy.

What are inguinal lymph nodes?

Lymph nodes are small, oval-shaped structures that produce disease-fighting cells. Lymph nodes are found throughout your body and are connected by a network of thin tubes (lymphatic system). The tubes filter and return fluid from your body to your bloodstream. Inguinal lymph nodes are located in your groin.

A chain of about 10 superficial (close to the surface of your skin) inguinal lymph nodes is located in your upper inner thigh. These nodes drain into three to five deep inguinal lymph nodes in the connective tissue of your upper thigh. From there, lymph fluid drains into other lymph nodes in your pelvis and then out to the rest of your body.

Why would you need an inguinal lymph node dissection?

Cancer cells can travel to other parts of your body through your lymph nodes. Because your lymphatic system drains in a predictable pattern, the fluid from a particular area of your body will flow to specific lymph nodes (sentinel lymph nodes). Cancers that start in your penis, vulva, anus and the skin on your legs or your torso tend to move to the inguinal lymph nodes first to travel to other parts of your body.

Healthcare providers use a sentinel lymph node biopsy (SLNB) to remove the first node in a group of lymph nodes that a particular cancer is most likely to spread to. If the “sentinel” lymph node is free of disease, then other nodes around it should also be cancer-free. Providers use an inguinal lymph node biopsy to check and see if cancer in nearby areas of your body has spread, or if it’s likely to be in other areas of your body (metastasized).

If the biopsy shows cancer in your inguinal lymph nodes, removing them can keep cancer from spreading further. Knowing whether there are cancer cells in your nearby lymph nodes can also help your provider choose the right treatment plan for you.

What is inguinal lymph node dissection used for?

Inguinal lymph node dissection is used to:

• See if cancer has spread from certain areas (usually your penis, vulva, anus or the skin on your legs or torso).
• Remove lymph nodes that may be cancerous or have a high chance of becoming cancerous. This includes cancer that might exist in your lymph nodes even after other treatments.
• Reduce the risk that cancer will come back in the future.
• Help providers understand the options for treating your cancer and help you know what to expect.

How does inguinal lymph node dissection work?

During an inguinal lymph node dissection, a surgeon removes lymph nodes and surrounding tissue in your groin area. They’ll send the lymph nodes to a pathologist, who’ll examine and test them for abnormal cells that could mean the cancer has spread.

How do I prepare for inguinal lymph node dissection?

Your provider will give you information on how to prepare for a lymph node dissection. You may need to stop medication or not have anything to eat or drink within a certain time before the surgery. They’ll also let you know how long you can expect to stay at the hospital and how to plan for recovery.

How is inguinal lymph node dissection done?

The general steps of an inguinal lymph node dissection include:

1. A provider gives you general anesthesia through a vein in your arm. This keeps you comfortable and asleep. You won’t remember the procedure.
2. A provider makes an incision (cut) in the skin of your groin to remove the lymph nodes they want to study. This could be only superficial (near the surface of your skin) nodes or both superficial and deep nodes. They’ll also remove the fatty tissue around them.
3. A provider puts tubes in place to drain excess fluid. They close the cut with stitches.
4. A provider attaches a bag to the end of the tube to collect any fluid drainage. This can remain in place for a few days to several weeks.
5. The provider sends all the tissue they removed to a laboratory to be examined.

Some providers now perform inguinal lymph node dissections robotically. This reduces your risk for complications.

What can I expect after inguinal lymph node dissection?

You might remain in the hospital for two to four days, though some people need to stay longer. Your provider will encourage you to walk around as soon as it’s safe for you to do so. Your drainage bag will remain in place until the amount of fluid being drained slows to a targeted amount or until your provider decides it’s safe to remove.

How long is recovery after lymph node removal in your groin?

It can take several weeks to recover from lymph node removal. You’ll have to restrict physical activities, like driving, for about four to six weeks. Your provider will let you know what activities you can and can’t do while you recover.

What are the possible risks and side effects of inguinal lymph node dissection?

All surgery comes with some risk. The most common complications and side effects of inguinal lymph node removal are:

• Infection at the incision site.
• Fluid buildup and swelling at the incision site.
• Swelling (lymphedema) in your lower legs.
• Blood clots (DVT).
• Poor wound healing.
• Numbness in your upper thigh. This is usually a long-term side effect of inguinal lymph node removal because nerves are removed during the procedure.

What type of results do you get after inguinal lymph node dissection? What do the results mean?

A pathologist will examine the removed lymph nodes for cancer. Lymph nodes that have cancer cells present are considered “positive.” Lymph nodes without cancer cells are “negative.” The pathologist will note the number of positive lymph nodes versus the total number removed.

They may also note:

• The type of cancer.
• The grade. How similar it looks compared to normal cells.
• The mitotic rate. How quickly the cells are dividing.
• The margins. If you have a biopsy done on tissue other than your lymph nodes, your report may say that margins are positive or negative. A positive margin means there were cancer cells found around the edges of the tissue. Negative or “clear” margins mean cancer cells weren’t found at the edges of the tissue.

When should I know the results of inguinal lymph node dissection?

Getting the results of your biopsy could take anywhere from a few days to a week or more. Ask your provider when you can expect to receive your results.

If the results are abnormal, what are the next steps?

If your results are abnormal, your provider will let you know what the next steps are. You might need additional treatments or procedures.

When should I call my doctor?

Call your provider right away if your incision isn’t healing or there are signs of infection, including:

• Fever.
• Pain.
• Redness, pus or discharge at the incision site.