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Lymph node dissection is a surgical procedure in which the lymph nodes are dissected, and a sample of tissue is checked for the presence of cancer under a microscope. It is an operation usually performed as part of the surgical management of malignant tumors and can be further divided into regional lymphadenectomy and radical lymphadenectomy. This activity reviews and explains the role of the interprofessional team in evaluating and managing patients who undergo lymph node dissections. Objectives: Identify the indications for lymph node dissection. Review the complications associated with lymph node dissection. Describe the equipment for lymph node dissection. Access free multiple choice questions on this topic.

Lymph node dissection, also known as lymphadenectomy, is a surgical procedure in which the lymph nodes are dissected, and a sample of tissue is checked for the presence of malignancy under the microscope. It is an operation usually performed as part of the surgical management of malignant tumors. Lymph node dissection can be further divided into regional lymphadenectomy, where there is a removal of some of the lymph nodes in the tumor area (inguinal, femoral, iliac, epitrochlear, cervical, popliteal, retroperitoneal, or axillary lymph node groups) and radical lymphadenectomy where there is a dissection of most or all of the lymph nodes in the tumor area. Finding cancer cells in the lymph nodes is associated with a higher risk of metastasis to other parts of the body and portends a poorer prognosis. The region of lymph node dissection depends on the site of involvement. The four most common dissection sites are axillary lymph nodes (for breast cancer), inguinal lymph nodes (for penile, anal, and vulvar cancers), cervical lymph nodes (for head/neck cancers and thyroid cancers), and retroperitoneal lymph nodes (for testicular and ovarian cancers).[1][2][3]

Although lymph node dissection is an important part of cancer assessment and treatment, as with any other surgical procedure, complications can occur. Complications depend on the site and extent of the dissection.[22] Common complications include pain, numbness, and surgical wound infections. Patients may also develop lymphedema, which is swelling and edema of the arms or lower limbs, which happens due to the accumulation of lymph in the interstitial tissue, causing the affected area to feel heavy and swollen.[23] Depending on the type of surgery and lymph node dissection, various other complications may occur. Pancreatic fistula, hemorrhage, bile duct injury, and chylous fistula are complications specifically related to lymph node dissection performed in gastric cancer surgical operations.[24] Also, the dissection of more than 14 retroperitoneal lymph nodes is an independent risk factor for the occurrence of postoperative complications such as deep vein thrombosis, extra operative site infections, lymphocytes, relaparotomy, febrile morbidity, and wound dehiscence in patients undergoing surgical staging for endometrial carcinoma.[25] Complications specifically related to axillary lymph node dissection include lymphedema, paresthesia, seroma, lymphocele, hematoma, lymphatic fibrosis, and axillary vein thrombosis.[26][27] Furthermore, central and lateral cervical lymph node dissection for thyroid cancer is associated with severe morbidities such as intra-operative and post-operative bleeding, damage to the facial nerve or vagus, and respiratory distress.[28]

Patients undergoing lymph node dissection require an inter-professional team approach. General surgeons and other specialized surgeons conduct these surgeries. Pathologists will then look for cancerous cells within that lymph node. Medical and radiation oncologists, anesthesiologists, radiologists, and other healthcare professionals are also part of this interdisciplinary team who help diagnose, treat, and follow these cancers.