A lymphectomy is a surgical procedure that involves the removal of one or more lymph nodes from the body. Lymph nodes are small, bean-shaped organs that are part of the lymphatic system, which helps filter waste and fight infection. The primary reason for performing this surgery is for cancer treatment, serving as a step in both the staging and management of the disease. By examining the removed nodes, doctors can determine if cancer cells have begun to spread from the primary tumor to other parts of the body. This information guides subsequent treatment decisions, such as the need for chemotherapy or radiation.
Indications and Types of Lymphectomy
The decision to perform a lymphectomy is usually driven by the need to understand or treat the spread of cancer. This procedure is most commonly associated with cancers of the breast, melanoma, and certain gynecological or head and neck cancers. The extent of the surgery depends on the clinical situation, leading to two main procedural types.
Sentinel Lymph Node Biopsy (SLNB)
The most targeted approach is the Sentinel Lymph Node Biopsy (SLNB), which focuses on identifying and removing only the “sentinel” node. This node is the very first one to receive lymphatic drainage from the tumor, making it the most likely place for cancer cells to travel first. If this specific node is free of cancer, it is highly probable that the disease has not spread to other nodes in the region, avoiding a more extensive surgery.
Complete Lymph Node Dissection (CLND)
A more comprehensive procedure is the Complete Lymph Node Dissection (CLND), sometimes called an Axillary Dissection when performed in the armpit. This involves removing a larger group or cluster of lymph nodes from a specific region, such as the armpit or groin. CLND is typically performed when the sentinel node biopsy is positive for cancer, or when imaging suggests that multiple nodes are involved. Removing a greater number of nodes provides a more thorough removal of potential disease but is associated with a higher risk of long-term side effects.
The Surgical Procedure and Immediate Recovery
A lymphectomy is performed under general anesthesia. For an SLNB, the surgeon uses a combination of a colored dye and a radioactive tracer, injected near the tumor site, to locate the sentinel node. This tracing substance travels through the lymphatic channels to highlight the first-draining nodes, which are then surgically removed through a small incision. In a complete lymph node dissection, the incision is generally longer to allow for the removal of the entire cluster of nodes and surrounding tissue.
The length of a hospital stay varies; many patients undergoing an SLNB can return home the same day or the next. Patients who have a CLND often require a one to two-night stay for monitoring and pain management.
A common element of the immediate post-operative period is the use of surgical drains, especially after a CLND. These thin, flexible tubes are temporarily placed in the surgical site to prevent the buildup of fluid, known as a seroma. The drains are typically removed once the fluid output decreases to a minimal amount, which can take anywhere from a few days to a few weeks. Managing post-operative pain is accomplished with oral medication, and patients are encouraged to begin gentle exercises soon after surgery to restore mobility and prevent stiffness in the affected limb.
Lymphedema Risk and Lifetime Management
The most significant long-term consequence of a lymphectomy is the risk of developing lymphedema, a condition characterized by chronic swelling. This swelling occurs because the removal of lymph nodes disrupts the normal pathways for lymphatic fluid to drain from the limb. When the fluid cannot be properly returned to the circulatory system, it accumulates in the soft tissues, most commonly in the arm or leg.
Symptoms can range from a mild feeling of heaviness or fullness to significant, visible swelling, skin tightness, and reduced flexibility in the affected limb. Lymphedema can develop at any point after surgery, sometimes appearing within months, but for others, it may not manifest for many years. The risk is significantly higher after a Complete Lymph Node Dissection (20–30%) compared to a much lower risk following a Sentinel Lymph Node Biopsy.
Lifetime management is focused on controlling the swelling and preventing complications such as recurrent skin infections or cellulitis. The standard of care is Complete Decongestive Therapy (CDT), a non-surgical program that involves several components.
Complete Decongestive Therapy (CDT)
Manual Lymphatic Drainage (MLD) is a gentle, specialized massage technique performed by a certified therapist to reroute the fluid to functional lymph vessels. Following MLD, multi-layered compression bandaging is often applied to reduce the limb volume. This reduction is later maintained with custom-fitted compression garments, such as sleeves or stockings. Regular, light physical activity is also encouraged, as muscle contraction helps to pump the lymphatic fluid out of the limb. Meticulous skin care is another component, since the swollen tissue is more vulnerable to cuts and infection, which can trigger or worsen the lymphedema.