Lymph node dissection is a surgical procedure involving the removal of one or more lymph nodes from a specific area of the body. This operation is typically performed in people diagnosed with cancer to evaluate and treat the spread of the disease. Lymph nodes are small, bean-shaped organs that form a network throughout the body as part of the lymphatic system. These structures function as filters, trapping foreign materials, bacteria, and damaged cells, including cancer cells, within the lymph fluid. They are often found clustered in areas like the neck, armpits (axilla), and groin.
Purpose and Role in Cancer Staging
The primary reason for performing a lymph node dissection is to determine if cancer cells have spread from the original tumor site, a process known as metastasis. Many solid tumors, such as breast cancer and melanoma, tend to spread first through the lymphatic channels to the nearest lymph node basin. Removing and examining these nodes helps doctors understand the extent of the disease, which is both diagnostic and therapeutic.
If cancer cells are found, the procedure acts as a localized treatment by removing those affected nodes. The status of the lymph nodes is a major factor in determining the cancer’s stage, categorized as the “N” stage in the Tumor, Node, Metastasis (TNM) staging system. A positive lymph node status indicates a higher risk of the cancer spreading to other parts of the body. This information is used by the oncology team to customize treatment plans, which may involve additional therapies like chemotherapy or radiation.
Types of Lymph Node Dissection Procedures
The surgical approach is determined by the type and location of the cancer, as well as the suspected extent of spread. Procedures are categorized based on the number of nodes removed.
The less invasive method is the Sentinel Lymph Node Biopsy (SLNB), which is the preferred method for many early-stage cancers. The sentinel node is the first node or group of nodes that receives lymphatic drainage directly from the primary tumor site. Surgeons locate this node by injecting a radioactive tracer or blue dye near the tumor, which then travels to the sentinel node, making it visible for targeted removal.
If the sentinel node is free of cancer, a more extensive surgery is often avoided. However, if the sentinel node contains cancer cells, the surgeon may proceed with a Complete Lymph Node Dissection (CLND). This procedure involves removing a larger group of lymph nodes from that specific anatomical region. For example, a complete axillary lymph node dissection typically removes between 10 and 40 nodes from the armpit area.
Dissection is performed in various regions depending on the tumor’s location. Common sites include the axillary region (for breast cancer or arm melanoma), the cervical region (for head and neck cancers), and the inguinal or pelvic regions (for lower body cancers).
Immediate Post-Operative Care and Recovery
Recovery begins immediately after the procedure, focusing on managing pain, preventing infection, and restoring mobility. Patients often wake up with a surgical drain, such as a Jackson-Pratt (JP) drain, placed near the incision site to collect fluid that naturally accumulates. This drain prevents fluid buildup, called a seroma, and is typically kept in place for one to three weeks until the volume collected decreases.
Pain at the surgical site is managed with prescription medication for the acute recovery phase. Patients are given specific instructions for wound care, which involves keeping the incision clean and dry and watching for signs of infection like excessive redness or fever. For procedures like axillary dissection, the hospital stay is often brief, ranging from one to a few days.
Movement restrictions are a major part of the initial recovery, particularly concerning the arm or leg on the affected side. Patients are instructed to avoid heavy lifting, pushing, or pulling for four to six weeks to prevent straining the surgical site and minimize swelling. Physical therapy exercises are often introduced early on to prevent stiffness and to help restore the full range of motion in the affected limb. A full return to normal daily activities can be expected between three and six weeks, depending on the extent of the dissection.
Understanding Lymphedema
A major long-term consideration after lymph node dissection is the risk of developing lymphedema, a chronic condition that occurs when the lymphatic system is damaged. Lymphedema is characterized by swelling, typically in the arm or leg, caused by the buildup of lymph fluid in the fatty tissues beneath the skin. This fluid cannot drain properly because the pathways and nodes responsible for filtering it have been removed or damaged.
The risk of lymphedema is directly related to the number of nodes removed; the risk is significantly lower (5% to 7%) following a sentinel lymph node biopsy compared to 20% to 25% following a complete lymph node dissection. Symptoms may develop gradually, sometimes years after the surgery, and include a feeling of heaviness, aching, or tightness in the limb, which precedes visible swelling. The skin in the affected area may also become tighter or harder over time.
While there is no cure, lymphedema is manageable through various strategies designed to encourage lymphatic fluid movement:
- Using custom-fitted compression garments or bandages, which apply pressure to the limb to prevent fluid accumulation.
- Learning Manual Lymphatic Drainage (MLD), a specialized gentle massage technique that helps reroute the lymph fluid toward functioning lymph vessels.
- Maintaining a regular exercise routine.
- Practicing vigilant skin care to prevent infection.