Lymph nodes are small, bean-shaped structures that form a part of the body’s immune system, distributed throughout the body with clusters in areas like the neck, armpits, and groin. They function as filters for lymph fluid, a fluid that circulates through lymphatic vessels, collecting waste products, harmful substances, and abnormal cells from the body’s tissues. Within the lymph nodes, specialized immune cells, including lymphocytes, identify and neutralize foreign invaders like bacteria, viruses, fungi, and damaged or cancerous cells. This filtering process helps protect the body from infection and disease. Lymph node removal may be necessary for various medical reasons, often to diagnose or manage certain health conditions.
Reasons for Lymph Node Removal
Doctors frequently remove lymph nodes to diagnose and stage cancer, determining if cancer cells have spread from their original site. This helps understand the disease’s extent and guide treatment.
One common procedure is a sentinel lymph node biopsy. This involves identifying and removing the first lymph node or nodes to which cancer cells are most likely to spread from a primary tumor. If these sentinel nodes are free of cancer, it suggests that the cancer has not spread to the lymphatic system, potentially allowing for less extensive surgery. Conversely, if cancer cells are found in the sentinel nodes, a more extensive lymph node dissection, or lymphadenectomy, may be performed to remove additional nodes in the area. This aims to remove any remaining cancerous nodes.
While cancer is the most common reason, lymph nodes may also be removed for chronic infections or inflammatory conditions. In such cases, removal can alleviate discomfort from persistently enlarged nodes or aid diagnosis when other methods are inconclusive.
Surgical Approaches to Lymph Node Removal
Removing lymph nodes involves various surgical techniques, depending on the location and the number of nodes to be extracted. Patients typically undergo general anesthesia for these procedures. Surgery duration varies by complexity, from under an hour for a sentinel node biopsy to several hours for a comprehensive dissection.
For procedures like a sentinel lymph node biopsy, surgeons often use mapping techniques to locate the specific nodes. This involves injecting a blue dye, a radioactive tracer, or both, near the tumor site. The dye or tracer travels through the lymphatic vessels to the first lymph nodes that drain the area, making them visible or detectable. A small incision (2-4 cm) is then made to remove these identified nodes.
More extensive procedures, such as axillary lymph node dissection for breast cancer, involve removing a larger group of lymph nodes from the armpit area. This requires a larger incision (4-8 cm) to access and remove multiple nodes. Similarly, neck dissection removes lymph nodes from the neck, often for head and neck cancers, with incision lengths varying by dissection extent. Inguinal lymph node dissection targets nodes in the groin region, typically for cancers of the lower extremities or pelvis.
The surgeon isolates the lymph nodes and their associated lymphatic vessels, severing them to remove the targeted tissue. Efforts are made to preserve surrounding nerves and blood vessels, though this is not always entirely possible depending on the extent of disease. Once the nodes are removed, they are sent to a pathology laboratory for microscopic examination to determine cancer or other abnormalities. The incision is then closed with sutures or staples.
Recovery and Potential Considerations
Following lymph node removal, patients can expect a hospital stay ranging from overnight for simpler procedures to several days for more extensive dissections. Pain management is a priority, typically involving prescribed oral pain medications, with intravenous relief if needed. Wound care is essential, including keeping the incision site clean and dry and monitoring for infection signs like redness, swelling, or discharge.
Many patients will have a surgical drain placed near the incision site to collect excess fluid. These small, flexible tubes are connected to a bulb or bag and typically removed when fluid output decreases, often within one to two weeks. Activity restrictions are common during recovery, limiting heavy lifting, strenuous exercise, and certain arm or leg movements to promote healing and reduce complications.
A significant consideration after lymph node removal, particularly with extensive dissections, is lymphedema. This condition involves chronic swelling in the affected limb or body part due to impaired lymphatic drainage. While not everyone develops lymphedema, it is a potential long-term effect, managed with compression garments, manual lymphatic drainage therapy, and exercises. Other potential post-operative issues include numbness or altered sensation due to nerve irritation or damage, and seroma formation (a collection of clear fluid under the skin that may require drainage). Follow-up care with the surgical team and physical therapists is important to monitor recovery, manage complications, and facilitate rehabilitation.