Lymphadenectomy
{{Short description|Surgical removal of lymph nodes}}
{{Infobox interventions |
Name = Lymphadenectomy |
Image = File:Lymph node NPC.jpg |
Caption = |
ICD10 = |
ICD9 = {{ICD9proc|40.2}}-{{ICD9proc|40.5}} |
MeshID = |
OPS301 = |
OtherCodes = |
synonyms = Lymph node dissection|
}}
Lymphadenectomy, or lymph node dissection, is the surgical removal of one or more groups of lymph nodes.Wagman LD. [http://www.cancernetwork.com/cancer-management-11/chapter01/article/10165/1399286 "Principles of Surgical Oncology"] in Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ (Eds) [http://www.cancernetwork.com/cancer-management-11/ Cancer Management: A Multidisciplinary Approach]. 11 ed. 2008. 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 area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed.{{cite web |url= http://www.cancer.gov/dictionary?CdrID=44435 |title=Lymph node dissection |work=NCI Dictionary of Cancer Terms |publisher=National Cancer Institute |access-date=30 July 2012|date=2011-02-02 }}{{cite web |url= http://www.cancer.gov/dictionary?CdrID=45763 |title=Lymphadenectomy |work=NCI Dictionary of Cancer Terms |publisher=National Cancer Institute |access-date=30 July 2012|date=2011-02-02 }}{{cite web |url= http://www.cancer.gov/dictionary?CdrID=44618 |title=Radical lymph node dissection |work=NCI Dictionary of Cancer Terms |publisher=National Cancer Institute |access-date=30 July 2012|date=2011-02-02 }}
Indications
Lymphadenectomies are usually done because many types of cancer have a marked tendency to produce lymph node metastasis early in their natural histories. This is particularly true of melanoma, head and neck cancer, differentiated thyroid cancer, breast cancer, lung cancer, gastric cancer, and colorectal cancer. Famed British surgeon Berkeley Moynihan once remarked that "the surgery of cancer is not the surgery of organs; it is the surgery of the lymphatic system."{{citation needed|date=February 2022}}
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.{{citation needed|date=February 2022}}
=With sentinel node biopsy=
For clinical stages I and II breast cancer, axillary lymph node dissection should only be performed after first attempting a sentinel node biopsy.{{Citation |author1 = American College of Surgeons |author1-link = American College of Surgeons |date = September 2013 |title = Five Things Physicians and Patients Should Question |publisher = American College of Surgeons |work = Choosing Wisely: an initiative of the ABIM Foundation |url = http://www.choosingwisely.org/doctor-patient-lists/american-college-of-surgeons/ |access-date = 2 January 2013}}, which cites various primary research studies. A sentinel node biopsy can establish cancer staging of the axilla if there are positive lymph nodes present. It is also less risky than performing a lymphadenectomy, having fewer side effects and a much lower chance of causing lymphedema. If cancer is not present in the sentinel lymph nodes, then the axillary lymph node dissection should not be performed.
If one or two sentinel nodes have cancer that is not extensive, then no axillary dissection should be performed, but the person with cancer should have breast-conserving surgery and chemotherapy appropriate for their stage of cancer.
Complications
Lymphedema may result from lymphadenectomy. Extensive resection of lymphatic tissue can lead to the formation of a lymphocele.{{citation needed|date=February 2022}}
It is uncertain whether inserting wound drainage after groin lymph nodes dissection can reduce complications such as seroma, haematoma, wound dehiscence, and wound infection.{{Citation|last1=Thomson|first1=David R|title=Wound drainage following groin dissection for malignant disease in adults|date=2014-01-20|url=https://ora.ox.ac.uk/objects/uuid:d7a0a5a4-2e47-4d36-bf78-9d21b8f0fb8d/files/m2d22e2a8154208795691b2a36b610e85|journal=Cochrane Database of Systematic Reviews|pages=CD010933|editor-last=The Cochrane Collaboration|place=Chichester, UK|publisher=John Wiley & Sons, Ltd|language=en|doi=10.1002/14651858.cd010933.pub2|access-date=2020-07-11|last2=Sadideen|first2=Hazim|last3=Furniss|first3=Dominic|issue=11|pmid=25387103}}
See also
References
{{Reflist}}
External links
- [http://pie.med.utoronto.ca/ALND/ Axillary Lymph Node Dissection - online learning resource]
{{NCI-cancer-dict}}
{{Operations and other procedures of the hemic and lymphatic system}}
{{Authority control}}