Lymph node removal, known medically as lymphadenectomy or lymph node dissection, is a procedure commonly performed as part of cancer treatment. This surgery involves removing lymph nodes from a specific region to determine if cancer cells have spread or to clear the area of disease. While necessary, the removal of these nodes and surrounding tissues can interrupt the body’s normal fluid drainage and sensory pathways. This interruption can lead to a range of side effects, from temporary post-operative issues to chronic conditions requiring long-term management.
Understanding Lymphedema
Lymphedema is a chronic condition characterized by the accumulation of protein-rich fluid in the soft tissues, resulting in swelling, typically in the arm or leg. This occurs because the surgical removal of lymph nodes damages or obstructs the lymphatic vessels, which are responsible for draining fluid from the surrounding tissues back into the circulatory system. When this fluid cannot drain effectively, it pools, causing the affected limb to increase in size.
The risk for developing lymphedema correlates with the extent of the surgery. Removing a larger number of nodes, such as in an axillary lymph node dissection, carries a higher risk than a sentinel lymph node biopsy. When lymph nodes are removed from the armpit (axillary dissection), the arm, hand, chest, or breast may be affected. Removal from the groin (inguinal dissection) can lead to swelling in the leg. Estimates suggest that 20 to 30 percent of patients who undergo axillary lymph node dissection may develop this condition.
Symptoms often begin with subtle changes, such as a feeling of heaviness, aching, tightness, or fullness in the affected limb. If left unmanaged, the skin may become thickened, fibrotic, and harder to the touch. Management focuses on techniques to redirect the fluid and prevent it from worsening, including:
- Wearing specialized compression garments.
- Performing specific exercises.
- Receiving manual lymphatic drainage massage.
These strategies encourage the remaining intact lymphatic pathways to take over the work of the damaged vessels and minimize the risk of complications like infection. Patients should maintain a healthy weight and protect the skin on the affected limb from cuts, burns, or trauma, as any injury can potentially trigger or worsen the fluid accumulation. Early detection and intervention by a certified lymphedema therapist are important for controlling the condition and improving long-term outcomes.
Short-Term Surgical Reactions
Immediately following lymph node removal, the body’s response to the surgical trauma can lead to several localized, acute complications at the incision site. One common issue is the formation of a seroma, which is a collection of clear, yellowish fluid that builds up under the skin where the nodes were removed. Seromas may feel like a soft, balloon-like lump near the wound and can cause discomfort or tightness, often appearing seven to ten days after surgery or after surgical drains are removed.
While many small seromas are reabsorbed by the body, larger or symptomatic ones may require aspiration, where a clinician drains the fluid using a needle and syringe. Another potential short-term complication is wound infection. Signs of infection include increased warmth, redness, significant pain around the incision, or the presence of pus or foul-smelling discharge.
Infections typically require treatment with antibiotics and, if severe, may necessitate a longer hospital stay. Issues with wound healing can also occur, such as dehiscence, where the incision edges separate, or excessive scarring and fibrosis. These acute reactions require prompt medical attention to ensure proper healing and prevent further complications.
Changes in Physical Feeling and Function
Beyond fluid drainage issues, lymphadenectomy can directly affect the surrounding nerves, leading to alterations in sensation and chronic discomfort. Nerve irritation or damage during the procedure can result in neuropathic pain, which patients often describe as burning, shooting, or stabbing sensations in the area. This nerve damage may also cause paresthesia, presenting as numbness, tingling, or a pins-and-needles feeling in the skin, which can sometimes extend down the back of the arm or torso depending on the location of the removed nodes.
The intercostobrachial nerve, which provides sensation to the armpit and part of the upper inner arm, is particularly vulnerable during axillary dissection. Injury to this nerve can lead to a loss of feeling that may be temporary or, in some cases, permanent.
In addition to sensory changes, the surgery can impact the body’s musculoskeletal mechanics, leading to functional limitations. Patients frequently experience stiffness, reduced range of motion, and muscle weakness in the joint closest to the surgical site, such as the shoulder after an armpit dissection.
This stiffness and limited mobility can be caused by scar tissue formation or an instinctive tendency to protect the surgical area during the initial recovery period. To mitigate these functional impairments, physical therapy and specific exercises are often recommended shortly after surgery to help restore strength and a full range of motion. Addressing these physical changes is important because persistent pain and stiffness can interfere with daily activities and long-term recovery.