What is inguinal lymph node dissection?
“Inguinal” refers to the groin, that part of the body where the legs meet the lower abdomen. “Dissection” refers to the cutting and separating apart of tissue. Therefore inguinal lymph node dissection is the surgical removal of lymph nodes from the groin.
Other names for this procedure are groin dissection or lymphadenectomy.
What are inguinal lymph nodes?
Inguinal lymph nodes are lymph nodes located in the groin. Other lymph nodes are found in the armpits, neck, behind the ears, and under the chin.
All lymph nodes are part of the lymphatic system, which includes lymph fluid, lymph vessels, bone marrow, and organs such as the thymus, adenoid, tonsil, and spleen. Lymphatic structures are part of the body’s immune system, making and transporting cells that fight against infections and other diseases.
Lymph nodes are small oval-shaped structures that produce disease-fighting cells, and also act as filters for lymph vessels, a network of thin tubes that collect and circulate lymph fluid throughout the body.
There is a chain of about 10 superficial (close to the surface of the skin) inguinal lymph nodes located in the upper inner thigh. These nodes drain into three to five deep inguinal lymph nodes in the connective tissue of the upper thigh. From there, lymph fluid drains into other lymph nodes in the pelvis.
When is inguinal lymph node dissection needed?
Cancer cells may travel in lymph fluid from the point where a cancer starts into lymph nodes. In the case of inguinal lymph nodes, they may receive cells from cancers of the penis, vulva, anus, and the skin on the arms and trunk of the body. If inguinal lymph nodes become cancerous, they can then spread cancer to the pelvic lymph nodes they flow into.
In the early stages of cancer, inguinal lymph nodes cannot be felt by hand. If large lymph nodes or a lump in the groin are detected, this could be an indication of a more advanced stage of cancer.
Inguinal lymph node dissection is used to diagnose, treat, and prevent the spread of cancer to the inguinal lymph nodes, as follows:
- To see if cancer is present in the lymph nodes of the groin: A surgical procedure called a sentinel lymph node biopsy (SLNB) removes the first lymph node in a chain or group of lymph nodes that a particular cancer is most likely to spread to. Because the lymphatic system drains in a predictable pattern, the fluid from a particular area of the body will flow to specific lymph nodes. It is presumed that if the “sentinel” lymph node is free of disease, then other nodes around it will also be cancer-free. This is confirmed when the removed node is examined and tested in a laboratory. Test results help the doctor determine if cancer is present. If it is present, laboratory results help determine the stage of cancer, a treatment plan, and the long-term outlook of the disease.
- To remove lymph nodes that may be cancerous.
- To remove lymph nodes with a high chance of becoming cancerous.
- To reduce the chance that cancer which is currently under control will come back in the future.
- To remove cancer that remains in the lymph nodes following treatments such as radiation or chemotherapy.
- To help doctors form a plan to treat cancer.
How is inguinal lymph node dissection done?
- The patient is placed under general anesthesia in a hospital operating room.
- The surgeon cuts into the groin and removes lymph nodes that may be cancerous. This could involve only superficial nodes or both superficial and deep nodes, depending on the patient’s particular case.
- A skin flap is created to cover the cut, tubes are put in place to drain excess fluid, and the cut is closed with stitches or staples.
- A bag is attached to the end of the tube to collect any fluid drainage, which could last for several weeks.
- All tissue removed is sent to a laboratory for testing to see if cancer cells are present. If yes, the important factors to consider are the type of cancer, the number of lymph nodes removed versus the number with cancer cells, and whether the cancer has spread beyond the lymph node. These factors help determine the stage of the disease, and possible treatments and outlook.
Risks / Benefits
What are possible complications of inguinal lymph node dissection?
The rate of complications following inguinal lymph node surgery can be quite high, with a direct correlation between the number and depth of the lymph nodes removed, and the occurrence of complications. The most common complications are:
- Infection at the site of the incision, an early complication and the one seen most often. A risk factor for developing infection is obesity. Signs of infection include pain, redness, pus, discharges or fever.
- Swelling (seroma) at the site of the incision due to fluid buildup.
- Swelling (lymphedema) of the lower legs, usually as a long-term complication.
- Deep vein blood clots.
- Poor wound-healing.
- Tissue death.
Studies are being done to reduce the number of surgical complications, which mainly are the result of bleeding and fluid accumulation due to damage done to blood and lymph vessels at or near the surgical site. Efforts at improvement include identifying nodal disease as soon as possible so that treatment can begin before extensive surgery is needed; changes in surgical technique; increased efforts at preserving as much tissue as possible, and a move toward less invasive surgery.
Recovery and Outlook
What can be expected following inguinal lymph node dissection?
- The drainage bag will remain in place until the amount of fluid being drained slows to a targeted amount, or until the doctor decides the bag is safe to remove.
- The patient may remain in the hospital for 10 to 14 days, although this can vary by patient.
- Attempts to walk are encouraged as soon as possible in order to avoid blood clots, although doing so may increase the amount of lymph fluid being drained.
- Driving a motor vehicle is discouraged for at least four to six weeks after surgery.