Lymphadenectomy or lymph node dissection is the surgical removal of one or more groups of

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

s. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.

Indications

It is usually done because many types of

cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...

have a marked tendency to produce lymph node

metastasis Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...

early in their natural history. This is particularly true of

melanoma Melanoma, also redundantly known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin, but may rarely occur in the mouth, intestines, or eye ( ...

head and neck cancer Head and neck cancer develops from tissues in the lip and oral cavity (mouth), larynx (throat), salivary glands, nose, sinuses or the skin of the face. The most common types of head and neck cancers occur in the lip, mouth, and larynx. Symptom ...

, differentiated

thyroid cancer Thyroid cancer is cancer that develops from the tissues of the thyroid gland. It is a disease in which cells grow abnormally and have the potential to spread to other parts of the body. Symptoms can include swelling or a lump in the neck. Ca ...

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or ...

lung cancer Lung cancer, also known as lung carcinoma (since about 98–99% of all lung cancers are carcinomas), is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, mali ...

gastric cancer Stomach cancer, also known as gastric cancer, is a cancer that develops from the lining of the stomach. Most cases of stomach cancers are gastric carcinomas, which can be divided into a number of subtypes, including gastric adenocarcinomas. Lym ...

and colorectal cancer. Famed British surgeon

Berkeley Moynihan Berkeley George Andrew Moynihan, 1st Baron Moynihan LL.D (2 October 1865 – 7 September 1936), known as Sir Berkeley Moynihan, 1st Baronet, from 1922 to 1929, was a noted British abdominal surgeon. Early years Moynihan was born in Malta in ...

once remarked that "the surgery of cancer is not the surgery of organs; it is the surgery of the lymphatic system". The better-known examples of lymphadenectomy are '' axillary lymph node dissection'' for breast cancer; ''radical neck dissection'' for head and neck cancer and thyroid cancer; ''D2 lymphadenectomy'' for gastric cancer; and '' total mesorectal excision'' for rectal cancer.

With sentinel node biopsy

For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting sentinel node biopsy., which cites various primary research studies. Sentinel node biopsy can establish

cancer staging Cancer staging is the process of determining the extent to which a cancer has developed by growing and spreading. Contemporary practice is to assign a number from I to IV to a cancer, with I being an isolated cancer and IV being a cancer that ha ...

of the axilla if there are positive lymph nodes present. It also is less risky than performing lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema. If cancer is not present in sentinel lymph nodes then the axillary lymph node dissection should not be performed. If one or two sentinel nodes have cancer which is not extensive, then no axillary dissection should be performed but the person with cancer should have breast-conserving surgery and

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemother ...

appropriate for their stage of cancer.

With sentinel lymph node mapping

The concept of sentinel lymph node mapping was popularized by Donald Morton and others. Cancer with various primary sites (breast, melanoma, colorectal, etc.) often metastasize early to the first drainage lymphatic basin. This process is predictable anatomically according to the primary site in the organ and the lymphatic channels. The first nodes (sentinel nodes) can be identified by particulate markers such as lymphazurin, methylene blue, India ink and radio-labelled colloid protein particles injected near the tumor site. The draining sentinel node can then be found by the surgeon and excised for verification by the pathologist if tumor cells are present, and often these tumor cells are few and only easily recognized by careful examination or by using techniques such as special stains, i.e. immunohistochemical. When the sentinel node is free of tumor cells, this is highly predictive of freedom from metastasis in the entire lymphatic basin, thus allowing a full node dissection to be avoided. The practice of sentinel lymph node mapping has changed the surgical approach in many cancer systems, sparing a formal lymph node dissection for patients with sentinel lymph node negative for tumor and directing a full node dissection for patients with sentinel lymph node positive for tumor metastases. For example, in stage II breast carcinoma, using the sentinel lymph node technique, 65% of patients could be spared from a formal node dissection.

Complications

Lymphedema may result from lymphadenectomy. Extensive resection of lymphatic tissue can lead to the formation of a lymphocele. It is uncertain whether inserting wound drainage after groin lymph nodes dissection can reduce complications such as seroma, haematoma, wound dehiscence, and wound infection.

References

External links