Lymph node dissections, or lymphadenectomies, are surgical procedures that play an important role in cancer treatments. A healthcare professional will remove the lymph nodes and check a tissue sample for any signs of cancer.

This article examines the purpose of lymphadenectomies and the different types available.

It also provides information about preparing for a lymphadenectomy, what to expect during the procedure, and the benefits and risks of lymph node dissections in adults and children.

A lymphadenectomy is a surgical procedure in which a surgeon dissects a person’s lymph node to remove a sample. A healthcare professional can then check this sample under the microscope for signs of cancer.

Lymph nodes connect to other parts of the body via the lymphatic system. The lymphatic system consists of lymph vessels, lymph nodes, and lymph fluid.

The lymph vessels carry lymph fluid from the tissues and into the lymph nodes. As a result, lymph fluid can carry cancer cells to the lymph nodes, resulting in the spread of cancer.

Additionally, according to a 2021 article, if cancer cells develop within a lymph node, there is a higher risk of the cancer spreading around the body, making it harder to treat.

People who have cancer cells in their lymph nodes tend to have a poorer outlook than those who do not.

The Canadian Cancer Society notes that a healthcare professional may perform a lymphadenectomy to:

  • check for cancer in the lymph nodes
  • reduce the chance of cancer returning
  • remove any lymph nodes that contain cancer
  • plan treatment

Before a lymphadenectomy, a healthcare professional may perform a sentinel lymph node biopsy.

This can happen when the person’s lymph nodes do not feel enlarged. It is less invasive than a lymphadenectomy and can help to discover if cancer has spread from a tumor to the sentinel lymph node. The sentinel lymph node is typically the first lymph node that cancer may spread to.

The National Cancer Institute (NCI) explains that doctors tend to divide lymphadenectomies into two main types — regional or radical.

A regional lymphadenectomy involves removing only some of the tumor-adjacent lymph nodes. A radical lymphadenectomy comprises removing most, or even all, of the tumor-adjacent lymph nodes.

Whether a person requires a regional or radical lymphadenectomy depends on the position and type of tumor.

The type of lymphadenectomy also depends on the region that requires the surgery. The four most common include:

  • Axillary lymph node dissection: Removes lymph nodes from the armpit and is associated with breast cancer.
  • Inguinal lymph node dissection: Removes lymph nodes from the groin and is associated with penile, anal, and vulvar cancers.
  • Cervical lymph node dissection: Removes lymph nodes from the sides and back of the neck, and is associated with head and neck or thyroid cancers.
  • Retroperitoneal lymph node dissection: Removes lymph nodes from the back of the abdomen and is associated with testicular and ovarian cancers.

People will be hospitalized one day before the surgery. This allows doctors to perform blood tests and chest radiographies to make the procedure as safe as possible.

Further preparation will depend on the kind of surgery a person is undergoing.

Shortly before surgery begins, the surgeons will ask the person for informed consent.

Questions to ask a doctor

People who are due to undergo a lymphadenectomy may have many questions. In most cases, a doctor will be the right person to approach. For example, an individual’s doctor should be well-placed to answer questions about:

  • the details of the surgery, which will depend upon the location of the cancer-adjacent lymph nodes
  • possible complications from the procedure
  • things to avoid doing before surgery
  • how to prepare for recovery

People who have a lymphadenectomy will usually be under general anesthetic.

Typically, a surgeon will make an incision to remove the lymph nodes and nearby tissue. They will then position a small tube or drain before closing the wound with stitches or staples.

They will then attach a drainage bag to the end of the tube.

Depending on the location or type of cancer, a surgeon can perform the procedure as laparoscopic or open surgery.

For example, surgeons will often use open surgery for people with breast cancer, making a 2-inch incision near their breast.

In people with testicular cancer, surgeons may have the option of performing laparoscopic or keyhole surgery. Unlike open surgery, keyhole surgery does not involve making any large incisions.

There is no fixed amount of recovery time or type of aftercare for all lymphadenectomies. It depends on the individual and the type of surgery.

A person’s doctor will be able to advise on a good post-surgery routine.

This can include instructions on:

  • caring for the wound
  • managing the tube and drainage bag
  • reducing swelling
  • reporting symptoms or side effects to a healthcare professional

After doctors test a person’s lymph node sample, they can determine whether or not the cancer has spread to the tumor-adjacent lymph nodes.

A positive lymph node has cancer cells present. If no cancer cells are present, the results will be negative.

What happens next depends on the results and the individual’s condition. For example, with skin cancer, Cancer Research UK (CRUK) explains that doctors rarely recommend surgery to remove further lymph nodes, even after a positive test result.

More common outcomes after a positive result include regular ultrasound scans to see if the person’s cancer progresses, and chemotherapy or targeted cancer medication.

As the NCI emphasizes, the benefit of a lymphadenectomy is that it gives doctors a better indication of the extent of someone’s cancer. This information can be beneficial, as it allows doctors to devise an optimal treatment plan.

Lymphadenectomies nonetheless carry their own risks. For example, radical lymphadenectomies can sometimes cause lymphedema, a condition that leads to swelling in the person’s arms and legs. The chance of someone developing lymphedema increases with the number of lymph nodes removed.

CRUK lists some further potential complications from lymphadenectomies:

  • fluid build-up near the surgery site
  • problems with wound healing
  • infections
  • nerve damage near the surgery site
  • blood clots
  • scarring

A person should talk with their doctor about the potential risks and complications of a lymphadenectomy.

Cancer is rare in children, according to a 2017 study. However, many children will have abnormally sized lymph nodes at some point, usually due to inflammation or infection.

If a child requires a lymphadenectomy, a surgeon will perform open or laparoscopic surgery, depending on the tumor’s size, type, and whether it has spread.

To help prepare a child for surgery, a caregiver can explain the following:

  • why they need the treatment and how it might help them
  • which part of the body the surgeon will perform the surgery on
  • who will perform the procedure
  • where the treatment will happen

If a caregiver is concerned or unsure, they should talk with a surgeon or healthcare professional.

After surgery, the child may need to stay in the hospital for 5–7 days, depending on the procedure. They will wear a dressing and may have a small tube attached that drains fluid from the surgery site.

The length of time that a child should stay at home will depend on their healing progress.

The outlook for someone who has had a lymphadenectomy depends on many factors.

These include the progression of that person’s cancer and any side effects from the lymphadenectomy itself.

Lymphadenectomies are surgical procedures that allow doctors to determine whether a person’s cancer has spread to the lymphatic system.

As with all surgeries, these procedures carry some risks. However, lymphadenectomies can save lives and help healthcare professionals decide on a person’s treatment plan.