Introduction
Lymph nodes are small, bean-shaped structures that serve as a filter for any foreign material entering the body. It plays an important role in cancer staging and finding any spread of cancer in the body. When involved in any disease, these lymph nodes are removed surgically by a procedure called lymphadenectomy.
What Is Lymphadenectomy?
The surgical removal of one or more lymph nodes or a group of lymph nodes is called lymphadenectomy or lymph node dissection. A section of tissue is obtained after their removal to test for the presence of cancer. The lymph node dissection is referred to as regional or radical dissection depending on the number of lymph nodes removed during the surgery.
Why Is Lymphadenectomy Done?
Lymph nodes, a part of the lymphatic system (contains white blood cells that fight against infections), help to filter the waste products from the body and return the filtered blood to circulation. Hence, they can also carry cancer cells and spread within the body. The spread of the cancer cells from the primary site (site of origin) to a distant location is called metastasis. Cancers of the breast, skin (melanoma), thyroid, head and neck, stomach, and lungs are the most common causes of metastasis to the lymph nodes. Removing the involved lymph nodes aids in finding the metastasis and reduces the chances of cancer recurrence and its spread.
What Are the Types of Lymphadenectomy?
The surgical procedure is broadly divided into two types, namely, regional and radical lymphadenectomy.
-
Regional lymphadenectomy involves the removal of only a few lymph nodes.
-
Radical lymphadenectomy removes almost all the lymph nodes near the tumor.
-
A sentinel node biopsy is a procedure wherein the lymph nodes close to the tumor site are examined for cancer. If positive, additional nodes are then removed.
Depending on the location of lymphadenectomy, they are described as:
-
Axillary Lymphadenectomy - The removal of lymph nodes in the armpit (axillary) region. These lymph nodes are mostly involved in breast cancer.
-
Inguinal Lymphadenectomy - The removal of lymph nodes in the groin (inguinal) region is associated with anal and vulvar cancer.
-
Cervical Lymphadenectomy - The removal of lymph nodes in the neck (cervical) region is associated with head and neck cancers.
-
Retroperitoneal Lymphadenectomy - The removal of lymph nodes in the back of the stomach (retroperitoneal) region. These lymph nodes are commonly involved in cancer of the ovary and testes.
-
Pelvic Lymphadenectomy - The removal of lymph nodes in the upper pelvis region. These lymph nodes are commonly involved in bladder, rectal and prostate cancer.
-
Mediastinal Lymphadenectomy - The removal of lymph nodes in the central part of the chest (mediastinal) region. These lymph nodes are commonly involved in lung cancer.
How to Prepare a Patient for Lymphadenectomy?
-
The doctor will provide all the information regarding the purpose, benefits, and possible risks involved with the procedure. The patient should sign a consent form as approval for the surgery.
-
Avoid having solid food about eight hours before the surgery and have some water just before surgery.
-
If the patient is under medications such as Aspirin (blood thinner), it has to be stopped a week before the surgery.
-
Allergies to anesthesia or medications are informed to the doctor to prevent complications.
-
Avoid smoking or alcohol consumption.
How Is the Procedure of Lymphadenectomy Done?
Lymphadenectomy is recommended to the patient as a treatment plan, to help in diagnosis, or after cancer therapy to ensure complete eradication of cancer cells. Before planning for the surgery, a radiograph and biopsy (testing of a sample of tissue or cells to identify an illness or cancer) of the lymph nodes are taken to confirm the presence of cancer. After all the tests are positive, lymphadenectomy is done for further confirmation. The whole procedure is done under general anesthesia and takes about an hour to complete.
-
The surgery can be done by laparoscopy (a fiber-optic instrument with a camera attached at one end called a laparoscope helps visualize the operation site from the outside) or open (using large cuts or incisions) technique.
-
In laparoscopic surgery, small incisions or cuts are made in the affected site and the instruments and laparoscope are introduced through these cuts to remove the lymph nodes. Since small incisions are used, the procedure is painless and has a faster recovery.
-
Open surgery involves the use of larger incisions or cuts in the affected area and the removal of lymph nodes with utmost care without damaging the adjacent structures. The operation site is closed with sutures, and a drain is placed to remove the fluid from the wound. Since a large incision is involved, it is a relatively painful procedure and has a slower healing period.
What Are the Benefits of Lymphadenectomy?
-
Helps the physician to examine the lymph nodes after the surgery and find information about the spread of cancer (metastasis) from the original site.
-
Helps to reduce or eliminate the cancer cells in the body.
-
Helps in staging and grading of cancer.
-
As a part of a treatment plan, lymph nodes are removed after proper investigation.
What Are the Risks Associated With Lymphadenectomy?
Some of the risks involved with the surgery are
-
Delayed wound healing due to infection.
-
If the drain is not placed, fluid gets built up at the site of operation.
-
Blood clots may form.
-
Injury to the adjacent structures like the blood vessel and nerves might occur if not removed with proper care. This can lead to pain and numbness at the surgical site.
What Are the After-Care Instructions for Lymphadenectomy?
-
The site of operation must be clean and dry.
-
Do not wear any tight-fitting clothes or jewelry that might irritate the surgical site.
-
The draining tube placed during the surgery is not removed until informed.
-
Avoid lifting heavy weights, exercising, and any activity that causes strain.
-
All the medications prescribed should be consumed regularly.
The surgeon must be informed when there are any symptoms of pain, swelling, bleeding, or any other difficulty to be managed immediately.
Conclusion
Lymphadenectomy is a minor surgical procedure used in cancer treatment and diagnosis. The overall success of the surgery depends on the stage of cancer spread and the risks or complications involved in the surgery. The side effects can be controlled by appropriate treatment. Hence, lymph node dissection helps to prevent cancer spread and has the ability to save a person’s life.
