Lymphadenectomy, also known as lymph node dissection, is a surgical procedure that involves the removal of one or more groups of lymph nodes. This procedure is commonly performed as part of cancer treatment, particularly for cancers that tend to spread through the lymphatic system. The primary purpose of a lymphadenectomy is twofold: first, it helps in staging the cancer by allowing pathologists to examine the removed lymph nodes for the presence of cancer cells, providing crucial information about the extent of the disease's spread.

Second, it can be therapeutic, potentially removing cancerous cells that have migrated to the lymph nodes, thus reducing the risk of cancer recurrence or further spread. Lymphadenectomy can be performed in various parts of the body, including the neck, armpit, groin, or abdomen, depending on the location and type of primary cancer. While this procedure can be an important part of cancer treatment, it also carries potential risks such as lymphedema (swelling due to disrupted lymph drainage), nerve damage, and infection. The extent of lymphadenectomy and its potential benefits versus risks are carefully considered by oncologists and surgeons when planning a patient's treatment strategy.

Types of Lymphadenectomies

There are two primary types of lymphadenectomies:

Regional Lymphadenectomy: This involves the removal of only some of the lymph nodes located near the tumour. This type of procedure is less invasive and is often used for early-stage cancers.
Radical Lymphadenectomy: This involves the removal of most or all of the lymph nodes in the area. This type of procedure is more extensive and is often used for more advanced cancers.

Purpose of Lymphadenectomy

This procedure serves several important functions in cancer treatment:

It helps determine if cancer has spread to the lymph nodes, aiding in accurate staging.
It removes potential sites of cancer metastasis.
It may prevent further spread of abnormal cells through the lymphatic system.

Which lymph nodes are removed?

The specific lymph nodes removed during a lymphadenectomy depend on the type and location of the primary cancer. Here's an overview of which lymph nodes are typically targeted for different cancer types:

Breast Cancer:

Axillary lymph nodes (under the arm)
Sentinel lymph nodes (first nodes where cancer is likely to spread)
Internal mammary nodes (near the breastbone)

Melanoma:

Sentinel lymph nodes
Regional lymph nodes near the primary tumour site

Head and Neck Cancers:

Cervical lymph nodes (various levels in the neck)
Submandibular and submental nodes (under the jaw and chin)

Lung Cancer:

Mediastinal lymph nodes (in the chest between the lungs)
Hilar lymph nodes (where the bronchi enter the lungs)

Gastric (Stomach) Cancer:

Perigastric lymph nodes (around the stomach)
Celiac lymph nodes
Hepatic lymph nodes

Colorectal Cancer:

Mesenteric lymph nodes
Para-aortic lymph nodes

Prostate Cancer:

Pelvic lymph nodes
Obturator lymph nodes

Gynaecological Cancers (Cervical, Ovarian, Uterine):

Pelvic lymph nodes
Para-aortic lymph nodes

Testicular Cancer:

Retroperitoneal lymph nodes (behind the abdominal organs)

Penile Cancer:

Inguinal lymph nodes (in the groin)
Pelvic lymph nodes

The extent of lymph node removal can vary from a sentinel lymph node biopsy (removing only the first few nodes where cancer is likely to spread) to a more extensive dissection.

Preparation of Lymphadenectomy

Before undergoing a lymphadenectomy, patients typically undergo a series of preparatory steps:

Medical tests are conducted to assess the patient's overall health and fitness for surgery.
Medications may be prescribed to minimize potential complications.
The surgical team determines the specific type of lymphadenectomy (regional or radical) based on the tumour's location and type.

Complications of Lymphadenectomy

While lymphadenectomy is an important procedure, it carries some risks:

Lymphedema: Swelling of a limb affected by removal of lymph nodes.
Numbness, tingling, or pain: In the area of surgery, which may be temporary or permanent.
Sloughing (breakdown) of skin: In the area of surgery.
Injury to motor nerves: This can affect various parts of the body.
Bleeding or lymphatic fluid accumulation: Under the skin.
Incisional infection

Procedure of Lymphadenectomy

The lymphadenectomy procedure involves several key steps:

An incision is made in the skin above the area of the affected lymph nodes.
Surgeons carefully remove the targeted lymph nodes, surrounding lymphatic tissue, and some underlying soft tissue.
The extracted tissue is sent for pathological evaluation, where it is examined under a microscope for signs of cancer.

Recovery Process of Lymphadenectomy

The recovery from lymphadenectomy involves several stages:

Patients typically spend a day in the hospital before surgery for final tests and preparations.
The procedure itself usually takes a few hours.
Post-operative recovery focuses on wound management, reducing swelling, and monitoring for any symptoms or side effects.
Patients are educated on how to recognize and report any concerning symptoms during their recovery.

Lymphadenectomy plays a vital role in cancer treatment and staging. While it carries some risks, the procedure provides crucial information and can be an essential part of a comprehensive cancer treatment plan. As with any medical procedure, patients should discuss the benefits and risks with their healthcare team to make informed decisions about their care.