A Complete Lymph Node Dissection Removes all the Lymph Nodes in the Region the Cancer Drains To.
This procedure is done in the operating room and usually requires an overnight stay. Sometimes, a drain is placed to keep the fluid from building up and is removed in clinic within the following weeks.
If lymph nodes are abnormally hard or large on clinical exam or seen on radiologic exams, a fine needle aspiration (FNA) biopsy or excisional biopsy can be done. If melanoma is found in a node or nodes, a lymph node dissection is usually done. Up until recently, most doctors recommended to remove the lymph node if there was a positive sentinel lymph node. However, a recent multi-center international clinical trial, MSLT-II which was conducted from the John Wayne Cancer Institute, showed no difference in survival between patients who underwent a complete node dissection versus those who were observed frequently with clinical exams and ultrasounds of the lymph node basin.
What to Expect
A completion node dissection is a procedure to remove the lymph nodes. This is done after a positive sentinel lymph node is found, or when one presents with a palpable lymph node or nodes. Typically this surgery is longer and sometimes requires an overnight stay in the hospital. Drains are placed at the time of the operation to help drain the fluid that may accumulate in the surgical site. The risk of lymphedema is higher than a sentinel lymph node procedure, so one should be aware if there is any swelling in the limb. Prompt referrals to physical therapy may help prevent further swelling.
Recovery and Side Effects
One complication after a complete lymph node dissection is lymphedema. Lymph nodes under the arm or in the groin function to drain fluid. Sometimes when they are removed, the fluid may accumulate and this is called lymphedema. This can cause swelling and may or may not go away. Elastic stockings, compression sleeves and physical therapy can help some people with this condition.
Because this surgery removes more than a sentinel lymph node biopsy, narcotic pain medicines may be used. You will learn how to care for your JP drain (Link to JP drain landing page) and receive instructions on when it can be safely removed. In general, you will be up and moving the day after the surgery, with some limitations in your physical activities. You will receive postoperative instructions.
Possible side effects after this procedure include:
• Numbness and/or sensitivity around the incision site
• Seroma, a collection of fluid in the surgical site. Most go away over time without any intervention, however sometimes they need to be drained in the office with a needle.
• Lymphedema, a chronic swelling in the arm and/or breast on the side of surgery can develop any time after surgery.
If lymph nodes in the groin or inguinal region have melanoma metastases, surgery to remove all the lymph nodes from that region. Because of the anatomy of that area of the body, the operation using the traditional “open” approach using a large skin incision is subject to a relatively high risk for wound complications. The minimally-invasive alternative uses smaller incisions (¼ to ½ inch) and special instruments and video cameras to perform the operation.