A lymphectomy, also known as lymph node dissection, is a surgical procedure involving the removal of one or more lymph nodes. Lymph nodes are small, bean-shaped glands that are part of the lymphatic system, a widespread network of vessels, tissues, and organs.
The lymphatic system plays a significant role in the body’s immune defense, filtering substances and maintaining fluid balance. Lymph nodes specifically filter lymphatic fluid, trapping damaged cells, bacteria, and other foreign substances, including cancer cells. They also store specialized immune cells, such as lymphocytes, which identify and destroy harmful invaders.
Reasons for a Lymphectomy
A primary reason for performing a lymphectomy is in the diagnosis and treatment of cancer. This procedure helps determine if cancer cells have spread to the lymph nodes, a process known as metastasis. Analyzing the removed lymph nodes helps doctors accurately stage the cancer, which aids in planning the most effective treatment approach.
The procedure also serves a therapeutic purpose by removing lymph nodes known to contain cancer cells. This aims to eliminate cancerous tissue and reduce the likelihood of recurrence or further spread, as lymph nodes are often the first place many cancers spread.
The Surgical Procedure
Lymphectomy can involve different approaches. Two common surgical methods are a sentinel lymph node biopsy (SLNB) and a more extensive lymph node dissection. An SLNB is a less invasive procedure where surgeons identify and remove the first few lymph nodes that drain fluid from a tumor. This approach is used for cancers like breast cancer and melanoma.
To identify these sentinel nodes, a surgeon injects a special blue dye or a weak radioactive substance near the tumor. The dye or tracer travels through the lymphatic channels to the sentinel nodes, making them visible or detectable with a specialized probe. If these initial nodes are free of cancer cells, it indicates that the cancer has not spread, allowing patients to avoid more extensive surgery. Conversely, if cancer cells are found in the sentinel nodes, a more comprehensive dissection may be performed. During an ALND, a larger group of lymph nodes, 10 to 40 in the armpit region, are removed through an incision.
Recovery and Immediate Aftercare
Following a lymphectomy, the immediate recovery phase often involves a hospital stay ranging from same-day discharge for sentinel node biopsies to one or more nights for extensive dissections. Patients experience soreness, swelling, and stiffness in the surgical area, which improves within a few days to weeks. Pain management is provided through prescribed medications, including over-the-counter options like acetaminophen or ibuprofen, and stronger pain relievers for severe discomfort.
Surgical drains are placed at the incision site to collect excess fluid and blood, preventing fluid buildup and promoting healing. These drains are left in place for several days to a few weeks, until fluid drainage decreases. Patients receive detailed instructions on how to care for the wound, manage the drain, and gradually reintroduce movement. Gentle exercises for the affected limb, taught by a physiotherapist, are encouraged to regain mobility and prevent stiffness, starting within 24 to 48 hours after surgery.
Managing Long-Term Effects
A long-term consideration after lymphectomy is the development of lymphedema, a chronic swelling caused by impaired lymphatic fluid flow. This condition occurs when the removal of lymph nodes disrupts the lymphatic system’s ability to drain fluid, leading to its accumulation in the affected area. Lymphedema can manifest months or even years after surgery and is considered a lifelong risk.
Management strategies for lymphedema focus on reducing swelling and preventing complications. Compression garments, such as sleeves or stockings, are used to apply graduated pressure to the affected limb to promote fluid movement and reduce swelling. These garments are worn during waking hours and should be replaced every 3 to 6 months due to diminishing elasticity.
Specialized physical therapy, including manual lymphatic drainage (MLD), involves gentle, skin-stretching massage techniques to encourage lymphatic fluid to move from swollen areas to healthier lymphatic pathways. Meticulous skin care is also important, involving daily washing, moisturizing, and promptly cleaning any cuts or scrapes to reduce infection risk. Maintaining a healthy body weight can also help manage lymphedema symptoms.