An inguinal lymph node dissection is a surgical procedure to remove the lymph nodes located in the groin. These are small, oval-shaped structures that are part of the body’s immune system. They function as filters, trapping foreign particles and producing disease-fighting cells to help combat infection. The lymphatic system, a network of thin tubes, carries fluid from the body’s tissues through these nodes. The primary purpose of this operation is to examine the nodes for the presence of cancer cells that may have spread from a nearby tumor.
Indications for an Inguinal Lymph Node Dissection
This procedure addresses cancers that tend to spread to the lymph nodes in the groin. Cancers such as melanoma of the skin on the legs or trunk, vulvar cancer, penile cancer, and anal cancer can shed cells that travel through the lymphatic fluid. These cancer cells can become lodged in the inguinal nodes and begin to grow, causing the nodes to swell. In some cases, the nodes may be enlarged enough to be felt during a physical examination, while in other instances, cancer is found after a sentinel lymph node biopsy.
Removing and analyzing the inguinal lymph nodes is a component of cancer staging. By examining the nodes under a microscope, a pathologist can determine if cancer is present and how many nodes are affected. This information helps doctors understand the extent of the disease and is used to plan subsequent treatments, which may include radiation therapy or chemotherapy.
The Surgical Procedure
The process begins with pre-operative evaluations, which can include imaging tests and a consultation with an anesthesiologist. The surgery is performed under general anesthesia, meaning the patient is asleep and feels no pain. The procedure itself lasts between one and a half to three hours.
Surgeons may perform either a superficial or a deep inguinal dissection. A superficial dissection removes the group of lymph nodes located closer to the skin, while a deep, or complete, dissection removes both the superficial and deep groups of nodes. The surgeon makes an incision in the groin to access and remove the lymph nodes and adjacent fatty tissue. Some medical centers offer a minimally invasive approach, which uses several small incisions instead of one large one, which may reduce infection risk and pain.
Following the removal of the nodes, the surgeon will place one or more thin plastic tubes, called surgical drains, into the area. These drains are connected to a small suction bulb and help remove excess fluid that collects in the space where the nodes were removed. The incision is then closed with stitches or staples. Patients are monitored in a recovery area after the surgery, and the hospital stay ranges from one to a few days to manage pain and monitor the initial healing process.
Recovery and Post-Operative Care
After discharge from the hospital, recovery continues at home for several weeks. Care involves managing the surgical drains. Patients and their caregivers are taught how to empty the fluid from the collection bulbs and record the amount, which helps the surgical team decide when the drains can be removed at a follow-up appointment.
Wound care is necessary to prevent infection and promote healing. This involves keeping the area clean and dry and following specific instructions from the surgical team on dressing changes. Pain is managed with prescribed pain medication. Patients are encouraged to walk and move around to prevent blood clots but are advised to avoid strenuous activities and heavy lifting for several weeks.
Follow-up appointments are scheduled to monitor the healing process, remove the surgical drains, and eventually take out any stitches or staples. The timing for returning to work and normal daily activities varies depending on the extent of the surgery and the individual’s healing progress.
Potential Complications and Management
A significant long-term risk following an inguinal lymph node dissection is lymphedema. This condition is characterized by chronic swelling in the leg on the same side as the surgery. It occurs because the removal of lymph nodes disrupts the normal flow of lymphatic fluid, causing it to accumulate in the limb. Symptoms include a feeling of heaviness, tightness, and visible swelling in the leg, foot, or groin.
Management of lymphedema is focused on controlling the swelling and preventing it from worsening. This often involves a referral to a physical therapist who specializes in lymphedema care. Treatment strategies include wearing custom-fitted compression garments, performing specific exercises, and undergoing a type of gentle massage called manual lymphatic drainage. Careful skin care is also important to prevent infections, as the affected limb is more susceptible to them.
Other potential complications include:
- Seroma, a collection of fluid under the skin after drain removal.
- Wound infections, which may require treatment with antibiotics.
- Hematoma, a collection of blood at the surgical site.
- Numbness or altered sensation in the upper thigh skin due to nerve irritation during surgery.