Lymphadenectomy
Lymphadenectomy, also known as lymph node dissection, is a surgical procedure that involves the removal of lymph nodes and is primarily utilized in the context of cancer treatment and diagnosis. This procedure is crucial since lymph nodes, part of the immune system, are often the first site where cancer spreads. Lymphadenectomy can be performed in a conservative manner, such as regional or selective lymphadenectomy, which samples nearby lymph nodes, or as a more extensive procedure, including radical lymphadenectomy, where all lymph nodes in a specific area are removed.
Commonly performed for various types of cancer—including breast, thyroid, head, stomach, neck, lung, melanoma, and colorectal cancers—lymphadenectomy serves both diagnostic and therapeutic purposes. Prior to the surgery, patients undergo tests like lymphangiography to locate the cancer and identify which lymph nodes to remove. The procedure typically occurs under general anesthesia and may involve real-time examination of lymph nodes during surgery.
While lymphadenectomy can provide critical information about the spread of cancer and may help manage its progression, it carries risks such as infection, bleeding, and the development of lymphedema, a condition characterized by swelling due to fluid accumulation. The outcomes of lymphadenectomy depend on factors such as cancer stage and the number of lymph nodes involved, with its success varying from diagnosis to treatment.
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Lymphadenectomy
ALSO KNOWN AS: Lymph node dissection
DEFINITION: Lymphadenectomy is the surgical removal of lymph nodes. It is used to stage, diagnose, and treat almost all types of cancers because lymph nodes are found throughout the body and are one of the first places to which cancer spreads. Regional or selective lymphadenectomy is a relatively conservative procedure to sample lymph node tissue near a tumor. A radical, total, or complete lymphadenectomy involves the removal of all lymph nodes in an impacted area.
Cancers diagnosed and treated: Most, including breast, thyroid, head, stomach, neck, lung, melanoma, and colorectal cancer.
Why performed: The lymphatic system is part of the immune system, which helps keep the body free of disease. Lymph is a clear, yellowish fluid that oozes out of blood vessels and is carried in channels throughout the body. Eventually, it is funneled back into a vein and reenters the circulatory system. Interspersed along the lymph channels are about six hundred enlarged areas called lymph nodes.
Lymph nodes filter bacteria, viruses, and cancer cells out of the lymph. These undesirable cells are then destroyed by white blood cells (lymphocytes) stored in the lymph nodes. There are many lymph nodes in the head and neck, another large cluster near the breast and under the armpit, and another group in the groin. When bacteria, viruses, or cancer cells overwhelm lymph nodes, the nodes swell and can be felt on the surface of the body. When the lymph nodes behind the ears and along the throat are enlarged, people often say they have “swollen glands,” although lymph nodes are not true glands.
Lymph nodes can be surgically removed as a diagnostic tool or as a therapeutic procedure to treat cancer. In a lymph node biopsy, several lymph node tissue samples are removed and examined under the microscope to see if they contain cancer cells. Based on the results of the biopsy, complete removal of some nodes (a lymphadenectomy) may be performed. To treat head, neck, or thyroid cancer, a radical neck dissection lymphadenectomy is performed. For rectal cancer, a total mesorectal excision lymphadenectomy is performed, and for stomach cancer, a D2 lymphadenectomy is performed. Following a sentinel node biopsy, an axillary lymph node dissection is an especially common lymphadenectomy procedure in treating breast cancer.
One newer approach to lymphadenectomy aimed at preventing unnecessary surgery involves identifying sentinel nodes and removing them first. Sentinel nodes are the first nodes to which lymph travels after it leaves the area where cancer is present. They provide an early warning that the cancer has begun to spread. The location of sentinel nodes is determined before surgery by lymphangiography and other imaging tests. Lymphangiography involves slowly injecting a fluorescent dye into the lymphatic system and tracing its progress using X-rays.
If no cancer is found in the sentinel nodes, then the cancer probably has not spread to the lymphatic system, and no additional nodes need to be removed. If cancer has spread to the sentinel nodes and beyond, then lymphadenectomy becomes a cancer treatment, and lymph nodes suspected of containing malignant cells are removed.
Patient preparation: Before a lymphadenectomy, various tests such as a lymphangiogram and other imaging scans are done to locate the cancer, determine where it is likely to have spread, and indicate to the surgeon which lymph nodes should be removed.
The patient is prepared for major surgery. In addition to tests to locate the cancer, the patient is given standard preoperative blood and liver function tests, meets with an anesthesiologist, and is required to fast for about eight hours before surgery.
Steps of the procedure: Lymphadenectomy is usually performed under general anesthesia in a hospital. An incision is made in the appropriate area, and lymph nodes and surrounding tissue are removed. Often, the sentinel lymph nodes or a sampling of other lymph nodes are removed and examined under a microscope while the patient is still on the operating table. The condition of these nodes then dictates how much other tissue the surgeon will remove. Temporary drains are inserted under the skin to remove excess lymph that accumulates, and the incision is closed.
After the procedure: This procedure normally requires a hospital stay. The length of stay and the recovery period depend on the number of nodes removed and the patient's general health. The patient may feel temporary numbness, tingling, or burning sensation in the region where the lymph nodes were removed. Radiation therapy or chemotherapy may be given after lymphadenectomy to help kill any cancer cells that remain in the body.
Risks: All surgery carries the risk of bleeding, infection, and allergic reaction to anesthesia. The greatest risk related to lymphadenectomy is the development of lymphedema after the operation. Lymphedema occurs when the lymphatic system is overwhelmed by large amounts of lymph. The lymph seeps into the surrounding tissue and causes swelling. About 15 percent of individuals have mild lymphedema, with 1 to 2 percent reporting severe swelling. Postoperative radiation therapy increases the risk of developing lymphedema. Other risks include fibrosis, numbness, stiffness, or seroma at the incision site.
Results: For diagnostic lymphadenectomy, if no malignant cells are found in the removed lymph nodes, it is unlikely the cancer has spread beyond the primary tumor. If lymph nodes are enlarged and malignant cells are found, there is a high chance the cancer may metastasize. Therapeutic lymphadenectomy may slow cancer but does not cure it. The success of this treatment depends on the stage of the cancer and how many lymph nodes are involved.
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