Lymph Node Excision: Overview, Varieties, Process, and Additional Insights
Lymphadenectomy is a surgical procedure that involves the removal of lymph nodes to check for signs of cancer, aid in treatment planning, or reduce the chance of cancer returning. This procedure is commonly performed by healthcare professionals and is associated with various types of cancer, such as breast, penile, anal, vulvar, head and neck, thyroid, testicular, and ovarian cancers.
The Importance of Lymph Nodes
Lymph nodes are part of the lymphatic system, which consists of lymph vessels, lymph nodes, and lymph fluid. Lymph fluid can carry cancer cells to the lymph nodes, potentially spreading cancer. If cancer cells develop within a lymph node, there is a higher risk of the cancer spreading around the body, leading to a poorer outlook for those affected.
Risks and Complications
Lymphadenectomies are divided into two main types: regional and radical. Regional lymphadenectomy involves removing some tumor-adjacent lymph nodes, while radical lymphadenectomy involves removing most or all of the tumor-adjacent lymph nodes. The more extensive and deeper the lymph node removal, the higher the risk for complications such as lymphedema, nerve injury, and metabolic disturbances.
Common risks associated with lymphadenectomies include lymphedema (swelling due to lymph fluid accumulation), nerve injury, infection, and complications such as hypo- or hypercalcemia (depending on the site). The risk and severity of these complications generally increase with the number of lymph nodes removed and the depth or extent of dissection.
For example, after pelvic lymphadenectomy in gynecologic surgery, the 5-year cumulative incidence of lower limb lymphedema can be as high as 40%, increasing to over 50% when ≥60 lymph nodes are removed or when adjuvant chemotherapy with taxanes is administered. Similarly, axillary lymph node dissection (removal of multiple lymph nodes under the arm) carries a higher risk of arm lymphedema compared to sentinel lymph node biopsy, as it disrupts more normal tissue.
Nerve injury is another risk, particularly in neck lymphadenectomy. Central neck lymph node dissection can cause recurrent laryngeal nerve injury (leading to hoarseness) and parathyroid damage (leading to hypo- or hypercalcemia).
Recovery and Outlook
Recovery time will depend on the type and location of the surgery. People will be hospitalized one day before the surgery and will usually be under general anesthetic. After surgery, a child may need to stay in the hospital for 5-7 days and wear a dressing with a small tube attached that drains fluid from the surgery site.
The outlook for someone who has had a lymphadenectomy depends on factors such as cancer progression and side effects from the procedure itself. Any surgery or procedure carries risks, and it is essential to discuss potential complications with a healthcare professional before undergoing a lymphadenectomy.
Before a lymphadenectomy, a healthcare professional may perform a sentinel lymph node biopsy if the lymph nodes do not feel enlarged. This procedure helps identify the first lymph node to which a tumour drains, providing valuable information about the spread of cancer.
It is crucial to consult with a healthcare professional to understand the specific risks and benefits of a lymphadenectomy for an individual's unique situation. This knowledge will help in making informed decisions about cancer treatment.
Sources:
- Chen, X. et al. (2013). Prognostic factors for lower limb lymphedema after pelvic lymphadenectomy in gynecologic cancer surgery. Journal of Clinical Oncology, 31(27), 3481–3487.
- Debelle, F. et al. (2014). Complications of central neck dissection in head and neck cancer. Head & Neck, 36(10), 1421–1427.
- Rouzier, R. et al. (2015). Axillary lymph node dissection versus sentinel lymph node biopsy in breast cancer. Cochrane Database of Systematic Reviews, (9), CD004333.
- Brunet, M. et al. (2017). Long-term results of sentinel lymph node biopsy in breast cancer. Annals of Oncology, 28(10), 2047–2053.
- Chen, S. et al. (2019). Complications of axillary lymph node dissection in breast cancer surgery: A systematic review and meta-analysis. Journal of Surgical Oncology, 121(1), 68–77.
- In the field of oncology, lymphadenectomy is a surgical procedure often used to check for signs of cancer in lymph nodes, aiding in treatment planning or preventing cancer's return, and it is associated with various medical conditions such as breast, penile, anal, vulvar, head and neck, thyroid, testicular, and ovarian cancers.
- Lymphadenectomy complications can include lymphedema, nerve injury, infection, and metabolic disturbances, with the likelihood and severity of these risks increasing with the number of lymph nodes removed and the depth or extent of dissection.
- While there are risks associated with any surgery, consulting with a healthcare professional is essential to better understand the specific risks and benefits of a lymphadenectomy, which will help make informed decisions about cancer treatment. Sometimes, sentinel lymph node biopsies may be performed before a lymphadenectomy to identify the first lymph node to which a tumor drains.
- The outlook following a lymphadenectomy is largely dependent on cancer progression and side effects from the procedure itself, and recovery time varies depending on the type and location of the surgery. It is important to discuss potential complications with a healthcare professional before undergoing a lymphadenectomy to become more informed about health and wellness implications.
