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Lymph node removal surgery (lymphadenectomy)

This page was reviewed under our medical and editorial policy by

Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on June 8, 2022.

After a cancer diagnosis, the doctor may want to check the patient’s lymph nodes for signs of disease. In a common procedure called a lymph node dissection, lymph node removal or lymphadenectomy, the surgeon removed one or more lymph nodes.

The lymph nodes are a part of the lymphatic system, also known as the lymphoid system. The lymphatic system is a network of lymph vessels, similar to a network of veins, found throughout the body. A clear fluid called lymph circulates through the vessels. Along the network are lymph nodes—small checkpoints that play important roles in the lymphatic system. Lymph nodes filter out germs, cancer cells and foreign matter. They also house white blood cells called lymphocytes that fight infection.

Lymph nodes and the lymphatic system are essential to a person’s general well-being, and because the body has hundreds of lymph nodes, it’s generally safe to remove some of them.

Why are lymph nodes removed in cancer patients?

A lymphadenectomy may be performed to check for signs of cancer and help determine a cancer’s stage. Many types of cancer tend to spread to nearby lymph nodes early in their progression. These include:

Cancers often use the lymph vessels as a highway to escape the organ they originally developed in and travel to other parts of the body. The stage of the cancer may be determined by how many local lymph nodes have signs of disease. Removal of cancerous lymph nodes may help stop the spread of cancer to other areas of the body.

Cancer cells using the lymph system to spread may get stuck in lymph nodes. Cancer cells may cause the lymph nodes to become enlarged. For lymph nodes under the skin, doctors may be able to tell if they’re enlarged simply by feeling them. However, many lymph nodes are deep inside the body and require evaluation using imaging procedures.

If testing lymph nodes is necessary, a biopsy may be performed first to see whether a lymph node is cancerous and needs to be removed. This procedure uses a needle to remove a sample of lymph tissue after the patient has been given local anesthesia. Sometimes, the decision is made to remove one or more nodes without taking a biopsy.

Whether a sample or an entire lymph node is removed, the tissues are sent to a lab for testing. A pathologist then analyzes the tissue under a microscope to look for cancer cells. This analysis helps determine how far the cancer has spread and how to treat it. When cancer has spread to the lymph nodes, treatment may involve chemotherapy, immunotherapy, targeted therapies and/or radiation therapy.

Types of lymphadenectomy

Lymph node removal surgeries differ based on:

  • How many nodes need to be removed
  • Where the nodes are located
  • How the surgery is performed

Lymph node dissection

A lymph node dissection or removal is sometimes confused with a lymph node biopsy. The difference is in the invasiveness of the procedure and how many lymph nodes the surgeon plans to remove.

Though biopsies tend to remove only a sampling of cells, they may include the surgical removal of a single lymph node for testing. This is typically the lymph node closest to the cancerous mass, also called the sentinel lymph node. A sentinel lymph node biopsy involves using a marker dye or radioactive substance injected into the tumor site. This marker is traced to the closest lymph node, which is removed and analyzed in a lab.

A lymph node dissection requires more invasive surgery and typically general anesthesia. Multiple lymph nodes are removed during dissection. This is sometimes done during surgery to remove the tumor itself.

Location of lymph nodes

There are hundreds of lymph nodes throughout the body, but four common areas are often targeted for lymph node removal depending on the type of cancer:

  • The axillary lymph nodes in the armpit
  • The inguinal lymph nodes in the groin and pelvis
  • The cervical lymph nodes in the neck
  • The retroperitoneal lymph nodes in the back of the abdomen

The extent of the removal

The name of the procedure will also include wording that describes how extensive the lymph node surgery is. Surgeries that remove few lymph nodes in a small region are called modified, limited or regional.

The terms radical or total describe more extensive surgeries—those that typically remove most or all lymph nodes in a specific region of the body.

Types of surgery

The surgeon performs a lymphadenectomy in one of two ways, often determined by the location of the lymph nodes being removed.

Laparoscopic surgery is performed through a laparoscope, a tube with a tiny light and camera that sends pictures to a monitor for the surgeon to see. The procedure involves a small incision. Tiny surgical instruments on the end of the scope are used to take a sample or fully remove the lymph nodes in question. This approach is typically used for lymph node removal surgeries in the abdomen.

Other lymphadenectomies are performed as open surgery, involving a larger incision that allows the surgeon to directly see and remove the lymph nodes.

What to expect before and after lymph node removal surgery

Before arriving at the surgical facility, you may be required to stop taking daily medications and fast for a certain number of hours. As with any surgery, smokers should stop smoking for as long as possible before and afterward.

General anesthesia is typically used for lymph node removal. This is typically an outpatient procedure, so the patient may be able to go home the same day.

Many lymph node dissection surgeries take about an hour. Some are longer or shorter depending on:

  • The location of the nodes
  • How many are being removed
  • Whether any complications arise during the operation

At the end of the procedure, a drain may be inserted before the incision is closed to allow fluid to exit the body and prevent buildup.

The patient will be monitored for several hours before being released. Pain medication and antibiotics may be prescribed, and instructions will be given on how to care for the incision site and any drain. Any pain or discomfort should ease within a few days.

At your follow-up appointment, you’ll review the results of the testing with your doctor, and if a drain was inserted, it’ll be removed.

Side effects of lymph node removal

A lymphadenectomy often causes some short- and long-term side effects. Short-term side effects of lymph node removal may include:

  • Pain, swelling and redness around the area
  • Infection
  • Limited movement
  • Numbness from nerve damage (but this is rare)

Most short-term side effects resolve on their own with time, but a buildup of fluid called lymphedema sometimes results and lasts for months or even years. The more lymph nodes removed, the more likely lymphedema is to develop.

Risk for lymphedema also varies based on the site of lymph node removal. For example, about 20 to 30 percent of patients undergoing removal of the lymph nodes in the armpit—which is common with breast cancer—develop lymphedema, according to the American Cancer Society. Symptoms of lymphedema include tingling sensations, swelling and changes to skin, including texture changes and hardening.

Other side effects specific to location of the removed lymph nodes include:

  • Stomach cancer: bleeding, pancreatic fistula (disruption of the pancreatic duct), bile duct injury or chylous fistula (leakage of lymph fluid)
  • Endometrial cancer and the dissection of a large number of retroperitoneal lymph nodes: blood clots and deep vein thrombosis, infections, fever and incision reopening
  • Face and neck lymph node removal: increased risks for bleeding, nerve damage and respiratory distress

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