Definition & Overview

Lymphadenectomy is the surgical procedure for removing lymph nodes and is commonly performed on cancer patients. The removed nodes are then examined to determine if cancer has metastasized or spread to other parts of the body.

Lymph nodes, which are found in the neck, under the arm, the pelvis, and the groin area, perform several important functions in the body. They offer much-need protection against pathogens by acting as filters against foreign organisms and materials. The lymphatic system is also responsible for removing excess fluid from tissues and returning them back into the circulatory system.

Cancer cells use lymph capillaries and bigger lymph vessels to travel to different areas of the body. As such, lymph node removal is performed as a means to manage the condition of cancer patients and as a way to prevent cancer from spreading to the rest of the body.

There are two types of lymphadenectomy: modified or limited lymphadenectomy in which the surgeon removes only some parts of the lymph nodes and total or radical lymphadenectomy in which all the lymph nodes in the affected area are removed.

Who Should Undergo & Expected Results

As more and more individuals are diagnosed with cancer every year, lymphadenectomy has become one of the most common procedures performed all over the world. Lymph node removal can be recommended for all cancer patients but it is more common among older individuals. The surgical area depends on the type of cancer that the patient has. For example, those suffering from breast cancer are operated in the underarm area.

A specific type of the procedure called D2 lymphadenectomy is for patients with gastric cancer while those with cancer in the head and neck are candidates for radical neck lymphadenectomy. The lymph nodes near the tumour site are considered sentinel lymph nodes since they are the first ones that would drain the cancer cells before being carried within the lymphatic system.

Lymph node removal requires hospitalisation and continuous monitoring even after the procedure. The excised or removed lymph nodes are examined by a pathologist to determine the presence of cancer cells. A node-negative result indicates that cancer has not metastasized while a node-positive result indicates the presence of cancer cells in the excised lymph nodes. These results are the basis of subsequent cancer management and treatment.

How Does the Procedure Work?

This procedure starts with the administration of anaesthesia to heavily sedate the patient. Lymphadenectomy can be performed using traditional open surgery or minimally invasive method. In an open surgery, the surgeon makes one incision in the area where the affected lymph nodes are located. Once the nodes are identified, they are carefully removed with little damage to the nearby tissues as possible.

Some surgeons would opt to perform laparoscopic lymphadenectomy or keyhole surgery, in which small incisions are made in the surgical area. A camera and several small surgical instruments are then inserted through the incisions and directed to the lymph nodes. Using a nearby monitor, the surgeon cuts and removes the lymph nodes.

A tube is then placed in the surgery area to drain excessive fluid, and the incisions are closed using sutures.

Possible Complications and Risks

During surgery, the patient is at risk of developing an allergic reaction to anesthesia and suffering from excessive bleeding, especially if a major blood vessel is injured.

Other possible complications include inflammation of the vein or phlebitis and damage to the nearby nerves, leading to temporary weakness, numbness, or tingling. If left unchecked or if the damage is extensive, these symptoms could become permanent and debilitating.

Patients who undergo lymphadenectomy could also suffer from lymphedema, a condition characterised by the swelling of the arms or legs. This is caused by the fluid build up in the lymphatic system following lymph node removal or damage. This complication has no cure and can occur a few days, months, or even years after surgery.

During lymphadenectomy to the neck, there is also the possibility of developing a hematoma, which could lead to wound infection and delayed healing.

References

  • Schaeffer EM, Partin AW, Lepor H, Walsh PC. Radical retropubic and perineal prostatectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 102.

  • Su LM, Smith JA Jr. Laparoscopic and robotic-assisted laparoscopic radical prostatectomy and pelvic lymphadenectomy. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 103.

Share This Information: