Also called lymph node dissection, it is the surgical removal of one or more groups of lymph nodes.
It is almost always done as part of the surgical treatment of cancer .
In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed. In a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.
It is usually done because many cancers have a marked tendency to metastasize to the lymph nodes early in their natural history.
This is particularly true of melanoma, head and neck cancer, differentiated thyroid cancer, breast cancer, lung cancer, gastric cancer, and colorectal cancer.
The famous British surgeon Berkeley Moynihan once commented that “cancer surgery is not organ surgery, but surgery of the lymphatic system.”
The best 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 .
Sentinel node biopsy
For clinical stages I and II, axillary lymph node dissection should only be performed after attempting sentinel node biopsy.
Sentinel node biopsy can establish armpit cancer staging if positive lymph nodes are present. It is also less risky than having a lymphadenectomy, has fewer side effects, and a much lower chance of causing lymphedema.
If cancer is not present in the sentinel lymph nodes, then axillary lymph node dissection should not be performed.
If one or two sentinel nodes have cancer that is not extensive, then an axillary dissection should not be performed, but the person with cancer should undergo breast-conserving surgery and chemotherapy appropriate to their stage of cancer.
Sentinel lymph node mapping
The sentinel lymph node mapping concept has been popularized by Donald Morton and others.
Cancer with several primary sites (breast, melanoma, colorectal, etc.) often metastasizes early to the first basin lymphatic drainage. This process is anatomically predictable based on the primary site in the organ and lymphatic channels.
The first nodes (sentinel nodes) can be identified by particle markers such as lymphazurin, methylene blue, India ink, and radiolabeled colloid protein particles injected near the tumor site.
The surgeon can find the draining sentinel node and remove it for verification by the pathologist for tumor cells, and these tumor cells are often few and far between and are only easily recognized by careful examination or using techniques such as special stains, i.e. immunohistochemistry. .
When the sentinel node is free of tumor cells, this is highly predictive of the absence of metastases throughout the lymphatic basin, thus avoiding a complete dissection of the nodes.
The practice of sentinel lymph node mapping has changed the surgical approach in many cancer systems, retaining a formal lymph node dissection for tumor-negative sentinel node patients and directing a whole node dissection for patients with metastasis-positive sentinel node tumorous.
For example, in stage II breast carcinoma, using the sentinel lymph node technique, 65% of patients could avoid a formal node dissection.
Lymph nodes can become swollen or enlarged as a result of invasion by cancer cells.
Swollen lymph nodes can be palpated (felt) during a physical exam. Before the lymph nodes are removed, a small amount of tissue is usually removed. A biopsy will be done to check for abnormal cells.
The patient will be asked to stop taking aspirin or aspirin-containing medications for a period of time before surgery, as they can interfere with the blood’s ability to clot.
Such medications may include prescription blood thinners (for example, Coumadin, generically known as warfarin and heparin). However, patients should discuss their medications regarding their upcoming surgery with their physicians, and not make any prescription adjustments or changes themselves.
Eating or drinking will not be allowed after midnight the night before surgery.
Some of the risks associated with lymphadenectomy include excessive bleeding, infection, pain, excessive swelling, inflammation of the veins (phlebitis), and nerve damage during surgery.
Nerve damage can be temporary or permanent and can lead to weakness, numbness, tingling, and / or falling.
Lymphedema is also a risk every time the lymph nodes are removed; it can occur immediately after surgery or months and years later.