A lymphadenectomy is a surgical procedure involving the removal of one or more lymph nodes. These small, bean-shaped glands are a component of the lymphatic system, a network of vessels and tissues that plays a part in the body’s immune defense. Lymph nodes function as filters, trapping foreign particles, damaged cells, and, in some cases, cancer cells that travel through the lymphatic fluid. The removal and subsequent examination of these nodes provide information about the body’s condition.
The procedure is performed for both diagnostic and therapeutic reasons, primarily in the context of cancer management. A lymphadenectomy can be a standalone procedure or part of a larger surgery to remove a tumor.
Purpose of a Lymphadenectomy
A primary reason for performing a lymphadenectomy is for cancer staging. After a primary tumor is diagnosed, surgeons may remove nearby lymph nodes to determine if cancer cells have spread, a process known as metastasis. The presence or absence of cancer in these nodes is a significant factor in determining the stage of the cancer, which guides treatment decisions. Finding cancer cells in the lymph nodes can indicate a higher risk of the cancer spreading to other parts of the body.
Beyond its diagnostic function, a lymphadenectomy is also a therapeutic procedure. When it is known or strongly suspected that lymph nodes contain cancer, removing them can be part of the treatment plan. The goal is to eliminate these cancerous deposits to prevent the disease from spreading further. This approach is common in the management of various cancers, including breast cancer, melanoma, thyroid cancer, and certain head and neck cancers.
Types of Lymphadenectomy Procedures
The least invasive type of lymph node removal is a sentinel lymph node biopsy (SLNB). This procedure identifies and removes only the first one or two lymph nodes that a tumor drains into, known as the sentinel nodes. To locate them, a surgeon injects a special blue dye or a weak radioactive tracer near the tumor. This substance travels through the lymphatic pathways to the sentinel nodes, making them identifiable for removal. The removed nodes are then examined by a pathologist.
If the sentinel nodes are free of cancer, it is unlikely that the cancer has spread, and no further lymph node surgery is typically needed. This approach avoids the more extensive surgery and potential side effects of a full dissection. SLNB is a standard procedure for staging cancers like breast cancer and melanoma.
In contrast, a complete or regional lymph node dissection is a more extensive operation. This procedure involves removing a larger group of lymph nodes from a specific area where cancer is known or suspected to have spread. For example, an axillary lymph node dissection (ALND) removes lymph nodes from the armpit, often in cases of breast cancer. A pelvic lymph node dissection (PLND) removes nodes from the lower abdomen for cancers such as prostate or bladder cancer.
The decision to perform a complete dissection is often based on the results of an SLNB. If the sentinel nodes contain cancer, a more extensive dissection may be recommended to remove additional affected nodes and reduce the risk of recurrence. These procedures are also called radical or total lymphadenectomies.
The Surgical Process
Before a lymphadenectomy, patients undergo standard pre-operative preparations, which may include physical exams, blood tests, and imaging studies. The surgery is performed under general anesthesia. The duration of the procedure can vary, with a standalone removal of a few nodes taking about an hour, while more extensive dissections performed with tumor removal will take longer.
The surgical technique depends on the location of the lymph nodes and the extent of the removal. A traditional open surgery involves a single, larger incision through which the surgeon accesses and removes the target lymph nodes and some surrounding tissue. This approach provides a clear view of the surgical area and is often used for more extensive dissections.
A minimally invasive approach, such as laparoscopic or robotic surgery, may be used for certain lymphadenectomies. This technique involves several small incisions through which a tiny camera and specialized surgical instruments are inserted. The camera provides a magnified view of the internal structures on a monitor, guiding the surgeon. This method can result in less pain and a quicker recovery for some patients.
Immediately following the surgery, one or more thin plastic tubes called surgical drains may be placed in the incision area. These drains help remove excess fluid that can accumulate after surgery, preventing swelling and promoting healing. The drains are typically left in place for a few days or weeks and are removed during a follow-up appointment.
Recovery and Potential Complications
Life after a lymphadenectomy involves a period of healing and adjustment, with a focus on managing potential long-term side effects. One of the risks following the removal of lymph nodes is the development of lymphedema. This condition is characterized by chronic swelling in the limb or body part corresponding to the area where nodes were removed. It occurs because the removal of lymph nodes disrupts the normal flow of lymphatic fluid, causing it to build up in the tissues. Symptoms include a feeling of heaviness, tightness, and visible swelling.
Managing lymphedema risk is a lifelong consideration. Patients are often advised to protect the affected limb from injury, burns, and infections, as these can trigger or worsen swelling. Preventative measures may include specialized exercises, maintaining a healthy weight, and wearing compression garments during activities like air travel. If lymphedema develops, treatment focuses on management through complete decongestive therapy, which involves manual lymphatic drainage massage, compression bandaging, and skin care.
Another common issue after surgery is the formation of a seroma, which is a pocket of clear serous fluid that collects in the space where the lymph nodes were removed. While many seromas are small and reabsorb on their own, larger ones may cause discomfort and require drainage with a needle in the doctor’s office. Surgical site infections are also a risk, characterized by redness, warmth, and pain at the incision site, and are typically treated with antibiotics.
Nerve damage is another potential complication that can occur during the procedure. The nerves that provide sensation to the skin are often located near the lymph nodes, and they can be stretched or cut during surgery. This may result in numbness, tingling, or sharp pain in the surgical area or down the affected limb. While sensation often returns over months or years for some, the numbness can be permanent for others.