Lymphadenectomy

What is a lymphadenectomy?

A lymphadenectomy is a surgical procedure to dissect and remove lymph nodes. Lymph nodes are glands in your lymphatic system, a network of vessels, tissues and organs that operates throughout your body. Your lymph nodes’ job is to filter lymphatic fluid (called lymph) and remove damaged cells and cancer cells. A lymphadenectomy looks for evidence of cancer in your lymph nodes.

Why is lymphadenectomy done?

When healthcare providers recommend a lymphadenectomy, it’s usually for someone who’s already been diagnosed with cancer. Dissecting the lymph nodes in the region of the tumor is a way of discovering whether cancer has spread beyond the tumor (metastasis). This is part of the cancer staging process. Staging helps healthcare providers determine the best treatment approach.

Who is lymphadenectomy for?

Lymphadenectomy (lymph node dissection) is recommended for people diagnosed with certain types of cancer that can spread to lymph nodes. As your lymphatic system is one of the main pathways cancer spreads through, a nearby lymph node is the most likely place it would spread to first. Dissecting and analyzing a few nodes can help reveal how far it has spread into your lymph system.

What conditions does lymphadenectomy help treat?

Lymph node dissection is simultaneously a diagnostic procedure and a treatment. If your surgeon finds cancer cells in the lymph nodes they dissect, you can be assured that those cancer cells were removed in the process. Finding cancer there will also prompt your surgeon to look further and remove more lymph nodes if necessary. Removing the affected lymph nodes stops the cancer from spreading.

Conditions that most commonly benefit from lymphadenectomy include:

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

What are the main types of lymphadenectomy?

The two main types are “regional” and “radical.” A regional (or “selective”) lymphadenectomy removes a sample of the lymph nodes local to the tumor. A radical lymphadenectomy (also called “complete” or “total” lymphadenectomy) removes all the lymph nodes in that region.

Sometimes, surgeons begin by dissecting a single lymph node nearest to the tumor and checking to see if it has cancer. This is called a sentinel node biopsy. If this node does have cancer, your surgeon may want to remove additional nodes to check them, too.

Which lymph nodes are removed?

Lymph nodes are located in clusters throughout your body. A lymphadenectomy targets one of these clusters, based on where your cancer is located. Certain cancers tend to spread through predictable pathways, beginning with certain lymph node clusters. Each cluster has a name. Your surgeon will target those lymph nodes and dissect one, some or all of them if necessary to screen for cancer.

For example:

• An axillary lymphadenectomy dissects the axillary lymph nodes located in your armpit. This is the first place that breast cancer or melanoma of the arm typically spreads.
• An inguinal lymphadenectomy dissects the lymph nodes located in the inguinal canal on either side of your groin. Penile cancer and vulvar cancer may spread here. An inguinofemoral lymphadenectomy goes a little deeper to also target the femoral lymph nodes in the femoral canal that lies beneath the inguinal canal.
• A cervical lymphadenectomy targets the cervical lymph nodes in your neck. This type of lymph node dissection is for head, neck and thyroid cancers. (“Cervical” here refers to your cervical spine, the top of your spinal cord that runs through your neck. A cervical lymphadenectomy isn’t for cervical cancer, which is cancer of the cervix, the lower part of your uterus.)
• A retroperitoneal lymphadenectomy targets the retroperitoneal lymph nodes in the back of your abdominal cavity. This is where testicular cancer and ovarian cancer tend to spread.
• A pelvic lymphadenectomy targets the pelvic lymph nodes (also called iliac lymph nodes) located in your upper pelvis. Bladder cancer, rectal cancer and prostate cancer commonly spread here.
• A mediastinal lymphadenectomy dissects the mediastinal lymph nodes in your center chest cavity. This is where lung cancer and lymphoma may spread. Sometimes, they also spread to the supraclavicular lymph nodes in your collarbone, and your surgeon may include these as well.

When does a lymphadenectomy happen?

You may have a lymphadenectomy at different points in your cancer treatment process. It may be an early diagnostic procedure before beginning treatment, or it may be part of a larger operation to remove a tumor. You may also have one after completing a course of cancer therapy, such as radiation therapy or chemotherapy, to check and make sure the cancer is all gone.

What happens before a lymphadenectomy?

Your healthcare provider will likely run some initial tests to check out your lymph nodes before scheduling a lymphadenectomy. They may try to visualize them with radiology first, to see if they look swollen or abnormal. They may also begin with a fine needle biopsy or a core needle biopsy to look for evidence of cancer in one node. If these tests appear positive, they’ll investigate further with a lymphadenectomy.

What happens during a lymphadenectomy?

You may have a lymphadenectomy through open surgery or laparoscopic surgery. Some medical centers may even perform a laparoscopic lymphadenectomy with robotic assistance. Laparoscopic and robotic surgery are minimally invasive techniques that allow surgeons to operate through small “keyhole” incisions. The method your surgeon uses will depend on the procedure and your overall condition.

A standalone lymphadenectomy is a relatively minor procedure that takes about an hour in the operating room. You’ll be asleep under general anesthesia for the operation. If you have open surgery, your surgeon will open the area with one incision. If you have laparoscopic surgery, your surgeon will use several small incisions. They’ll insert a camera into one and operate through another.

Your surgeon will remove the target lymph nodes and sometimes some of the surrounding tissue. They’ll send these samples to the lab to dissect and analyze for cancer. They’ll place a tube attached to a pouch inside the surgical wound before closing it. This is called a drain. It helps prevent fluid from collecting in the tissues. It will stay in place for a few days to weeks after your operation.

What happens after lymph node surgery?

If you had a standalone laparoscopic lymphadenectomy, you’ll likely be able to go home the same day. If you had open surgery or a larger procedure, you may need to stay in the hospital for one to three days. Your healthcare team will let you know how to care for your wound at home. You may have to come back in a week or two to have your drain or stitches removed and receive your biopsy results.

Is a lymphadenectomy painful?

Most people have mild pain during their recovery and manage well with over-the-counter medications. Some people have longer-lasting pain and stiffness in the area where their lymph nodes were removed, especially in their neck, shoulders and armpits. Be sure to consult your healthcare provider if you’re struggling with pain management or unusual symptoms during your recovery.

What are the benefits of lymph node dissection?

A lymphadenectomy can:

• Tell your healthcare provider if your cancer has spread (metastasized) beyond the initial cancer site.
• Help your provider stage your cancer and determine the best course of treatment.
• Remove the cancer cells that have invaded your lymph system and stop them from spreading.
• Prevent cancer from returning after your tumor is removed.

What are the risks of the procedure?

Risks of lymph node surgery include:

• Wound infection.
• Nerve damage.
• Damage to nearby vessels or organs.
• Blood clots.

What complications might develop after the procedure?

Side effects of having your lymph nodes removed can include:

• Fibrosis. Some people develop more extensive scar tissue than others. In severe cases, fibrosis could interfere with nearby vessels or muscles, causing pain or limiting movement.
• Numbness/stiffness. Damage to a nerve in the area may also cause stiffness or numbness, which may be short-term or longer-term. Exercises or physical therapy can help.
• Seroma. A buildup of fluid under your skin at the site of the operation is a common short-term side effect. Your lymphatic system needs to figure out where to redirect your lymph fluid.
• Lymphedema. Some people develop a condition of permanent fluid retention (edema), caused by excess lymphatic fluid collecting in their tissues. This is more likely when you’ve had many lymph nodes removed and when you’ve also undergone chemotherapy or radiation therapy, which damages your lymphatic system. Lymphedema can be mild or severe.

What is my prognosis after lymphadenectomy?

The results of your lymphadenectomy will tell you and your healthcare provider more about your cancer stage and prognosis. This will involve the stage and type of cancer being treated. If you did have cancer in your lymph nodes, you’re statistically more at risk of cancer recurring (returning) after treatment. However, removing the affected lymph nodes is the surest way of removing all the cancer cells.

When should I be concerned about my recovery from lymphadenectomy?

Call your healthcare provider if you experience:

• Signs of wound infection, such as redness, discharge or fever.
• Excessive pain, numbness or stiffness.
• Difficulty with certain movements.
• Excessive swelling in your hands, feet, arms and legs.

A note from Cleveland Clinic

Lymphadenectomy, or lymph node dissection, is an important step in staging and treating cancer. It gives your healthcare team crucial information about your condition and may stop cancer from spreading in the process. Like all surgeries, it can involve certain risks and complications, which may be short-term or long-term. Side effects may diminish your quality of life, but overall, lymphadenectomy may save it.