Completion Node Dissection

Complete Lymph Node Dissection (LND) involves removing all the lymph nodes in the affected region where the cancer can drain. This procedure is performed in the operating room and typically requires an overnight stay at our health center. At Saint John’s Health Center in Santa Monica, CA, we adopt a multidisciplinary approach to care, involving specialists across various disciplines. These experts participate in cancer tumor boards, where they evaluate and discuss each case in detail. 

Lymph Node Dissection Procedure

If lymph nodes appear abnormally hard or enlarged during clinical exams or radiologic exams, a fine-needle aspiration (FNA) biopsy or excisional biopsy may be performed. If melanoma is detected in a node or nodes, a lymph node dissection is usually recommended. Previously, most doctors advised removing the lymph node if a sentinel lymph node was found to be positive. However, a recent multi-center international clinical trial, MSLT-II, conducted by the Saint John’s Cancer Institute, showed no difference in survival between patients who underwent a complete node dissection and those who were frequently observed with clinical exams and ultrasounds of the lymph node basin.

What to Expect with Lymph Node Dissection

A completion node dissection is performed after a positive sentinel lymph node is found or when a palpable lymph node or nodes are present. This surgery is typically longer and may require an overnight hospital stay. Drains are placed during the operation to help remove fluid that may accumulate at the surgical site. The risk of lymphedema is higher than with a sentinel lymph node procedure, so it is essential to monitor the limb for any swelling. Prompt referrals to physical therapy can help prevent further swelling.

Recovery and Side Effects

One potential complication after a complete lymph node dissection is lymphedema. Lymph nodes under the arm or in the groin help drain fluid, and their removal can lead to fluid accumulation, known as lymphedema. This can cause swelling, which may or may not resolve over time. Elastic stockings, compression sleeves, and physical therapy can help manage this condition.

Since this surgery is more extensive than a sentinel lymph node biopsy, narcotic pain medications may be necessary. You will learn how to care for your JP drain and receive instructions on when it can be safely removed. Generally, you will be able to move around the day after surgery, although there may be some limitations on physical activities. You will receive detailed postoperative instructions.

Possible Side Effects 

• Pain
• Numbness and/or sensitivity around the incision site
• Seroma, a collection of fluid at the surgical site, which usually resolves over time but may occasionally need to be drained in the office with a needle
• Lymphedema, chronic swelling in the arm and/or breast on the side of surgery, which can develop at any time after surgery

Minimally Invasive Inguinal Node Dissection

If melanoma metastases are present in the lymph nodes in the groin or inguinal region, surgery is performed to remove all the lymph nodes from that area. Due to the anatomy of this region, traditional “open” surgery using a large skin incision carries an elevated risk of wound complications. The minimally invasive alternative uses smaller incisions (¼ to ½ inch) and special instruments and video cameras to perform the operation.

Benefits of Minimally Invasive Inguinal Node Dissection 

• Reduced risk of wound complications: Smaller incisions lead to fewer wound infections and dehiscence.
• Shorter hospital stays: Patients typically experience shorter recovery times and hospital stays.
• Comparable oncologic outcomes: The lymph node yield and recurrence rates are like those of the open technique.

Minimally invasive inguinal lymph node dissection (MILND) adheres to the same anatomic boundaries and oncologic principles as its open counterpart. This procedure significantly decreases the incidence of wound complications, surgical site infections, and wound dehiscence.

Contact the Saint John’s Health Center

The experts at Saint John’s Health Center and researchers of the Saint John’s Cancer Institute are ready to support you and help you navigate through this challenging time. Whether you are looking for an expert second opinion, a better understanding of your health situation, or access to personalized clinical trials, please reach out to us by calling 310-829-8317 or using our melanoma contact form. We are committed to providing you with the best possible care and outcomes.