Lymphadenectomy

Lymphadenectomy, or lymphadenectomy, is a surgical procedure that involves the removal of lymph nodes and their further examination for the presence of atypical cells. Lymphadenectomy is limited or complete, depending on the scale of the operation. The likelihood of developing complications after such a procedure is quite high. However, often the intervention allows you to stop the further spread of cancer structures, and thereby save the patient's life.

Indications for the procedure

The main target orientation of the lymphatic system is to transport fluid from tissues to the circulatory system and provide immunity, which implies protection against bacteria, viruses and atypical cells.

The lymphatic system consists of nodes, vessels and small vascular capillaries. Lymph flows through the vessels, and the nodes are bean-shaped formations localized along the entire system and acting as filters that trap any foreign objects.

The largest clusters of nodes are observed in the neck, armpits, pelvis and groin area.

The lymphatic system is the first to accept the spread of tumor cells from the focus to other points in the body: sometimes such cells stay in the lymph nodes and continue to grow there. This process is called metastasis. By removing several lymph nodes, the doctor can determine if the patient has metastasis.

Lymphadenectomy is used not only for diagnosis, but also to block further divergence of cancer structures in the body.

In addition, the indications are severe pain in the area of the lymph nodes, as well as the ineffectiveness of conservative therapy.

Lymphadenectomy for cancer is an integral stage of a qualified and complete approach to the treatment of oncopathology. Even before the operation, the surgeon clarifies the likelihood of damage to the "sentinel" lymph nodes and their groups, which are directly involved in the outflow of lymph from the area affected by the tumor process. Suspicion of the presence of metastases in a specific lymphatic collector is a direct indication for performing lymphadenectomy. As a rule, lymphatic capillaries, outgoing vessels, directions of lymph flow, including regional and distant lymph nodes, as well as surrounding tissue are subject to removal. Such an operation can significantly improve the quality of life of postoperative patients and accelerate their recovery.    

Preparation

The preparatory stage is not difficult, but mandatory. It includes the following sequential activities:

1. Consultation with the oncosurgeon who will perform the lymphadenectomy, as well as with the anesthesiologist.
2. Agreement on the main points and dates of the intervention.
3. Preoperative diagnostics, which includes a general urinalysis, general and biochemical blood tests, ultrasound, and sometimes a fine-needle biopsy of the lymph nodes.
4. Examination by a therapist, with an assessment of the likelihood of contraindications to surgery.
5. Cancellation of drugs that may negatively affect the course of the operation and the postoperative period (for example, non-steroidal anti-inflammatory drugs, barbiturates, heparin, etc.).
6. The day before the lymphadenectomy, the patient should limit the diet, do not overeat, give up heavy, fatty and sweet foods. Do not eat or drink on the day of surgery.

Technique lymphadenectomy

Most often, in the presence of oncology, surgeons resort to such types of operative lymphadenectomy as dissection of lymph nodes in the armpits (for breast cancer), cervical dissection (for cancer of the thyroid gland, or of the neck and head), D2 lymphadenectomy with the removal of nodes located in the stomach and liver. And spleen (for stomach cancer). [1]

In most cases, a qualified surgeon can predict which lymph nodes abnormal cells will move to during the spread of metastases. Those nodes that will be affected in the first place are called signal nodes. That is why the doctor first necessarily removes just such nodes, which are immediately sent for research - biopsy of sentinel lymph nodes.

To determine the priority nodes for lymphadenectomy, a mapping procedure is performed: a radioisotope substance (indicator) is injected into the affected area, indicating the direction of the lymph flow.

The duration of the lymphadenectomy operation is on average one hour. However, the duration may vary, depending on the nature of the surgery.

• Pelvic lymphadenectomy can be performed using laparoscopic and laparotomy access. When conducting laparoscopy, the conditions of pneumoperitoneum are observed (from 10 to 15 mm Hg), laparoscopy and trocars are used. The parietal peritoneum is dissected over the zone of the iliac vessels, in a parallel direction with the external iliac vessels. Be sure to examine the ureters. With the help of clamps, periaventic tissue is captured with lymph nodes and vessels located in the proximal region of the incision. A closed clamp peels off the tissue from the frontal part of the external iliac vessels. After that, the obturator nerve is isolated and all tissue localized around the internal iliac vessels, together with the lymph nodes, is removed. Lymph nodes located at the external iliac vein are especially carefully removed. It is preferable if the entire chain is excised as a whole. In conclusion, adipose tissue is removed with nodes localized in it from the gap between the external iliac arterial and venous vessels. The biomaterial is sent for histological analysis, the damaged vessels are coagulated to prevent bleeding - for this, electrosurgery is used. [2]
• Inguinal lymphadenectomy in the classical version is performed according to the description of the French oncologist Duquesne. The essence of the operation consists in excision of the lymph nodes of the femoral-inguinal zone together with tissue, fascia and an element of the great femoral saphenous vein. First, the surgeon makes a vertical incision above the middle of the inguinal ligament and below, dissecting it to the subcutaneous fat layer. The skin tissue is separated at the level of the superficial subcutaneous fascia. The subcutaneous fat is excised to expose the iliac abdominal wall and the entire femoral triangle. Next, the incision is extended to the underlying musculature, after which the large saphenous vein is isolated, bandaged and crossed at the apex of the femoral triangle. The tissue with the lymph nodes is pushed inward, the sartorius muscle is taken out with the help of hooks: this helps to examine the femoral-vascular bed. The removed tissue area and the outer wall of the vascular vagina are isolated from the femoral vessels, lifted up to the area of attachment of the great saphenous vein directly to the femoral vein. The biomaterial is removed and transferred for further research. [3]
• Axillary lymphadenectomy rarely takes more than 60 minutes. Typically, the surgeon makes an incision in the armpit area of about 50-60 mm. The intervention is carried out with the use of general anesthesia, sometimes in combination with a radical mastectomy. During a lumpectomy, the nodes can be removed later, or during surgery. In the classical version, mainly lymph nodes of the 1st row and the lower part of the 2nd row are removed, after which they are sent for histological examination. In general, about a dozen nodes are excised (complete lymphadenectomy involves excision of about two dozen nodes). In the full version, lymph nodes belonging to all rows of the axillary chain are excised, but such operations are currently not performed so often. Conservative intervention involves the dissection of tissues by five and seven centimeters in the armpit. The removed tissues are sent for examination, the results of which can be obtained in a few days. Such a diagnosis is necessary to prescribe further postoperative treatment, which may include chemotherapy, radiation, etc. [4]
• Cervical lymphadenectomy is due to the fact that metastases of oncological foci from the neck and head are often found in the regional cervical lymph nodes. In this case, the Crail intervention, named after the American surgeon, is considered the classic option. The operation consists in the complex removal of the suprahyoid, cervical and supraclavicular nodes on one side, simultaneously with the submandibular salivary gland, internal jugular vein, scapular-hyoid and sternocleidomastoid muscles. Cervical lymphadenectomy is indicated for cancer of the laryngeal-throat region, thyroid gland, salivary glands, tongue, mouth or nasopharynx. Most often, such surgical options are performed as radical removal of all cervical lymph nodes (level 1-5), modified or selective excision, or an extended radical method. Another common method is considered a gentle intervention, involving the removal of lymph nodes and tissue. This method is called functional cervical dissection: during the operation, the sternocleidomastoid muscle, the internal jugular vein and the accessory nerve are preserved. [5]
• Inguinal-femoral lymphadenectomy is used to eliminate cancer metastases in the inguinal and femoral lymph nodes. The surgeon makes two semi-oval incisions in a direction parallel to the groin. After dissection of the skin and subcutaneous fat layer, tissue flaps are separated up to the aponeurosis of the external oblique muscles of the abdomen and down to the middle of the femoral triangle. The inguinal ligament is transected by removing the fascia of the external oblique musculature. The pre-pubic tissue is removed, the base of the femoral triangle is exposed. Next, the fiber is cut, starting from the point of the anterior superior iliac spine to the middle of the femoral triangle, as well as from the tubercle of the pubic bone to the apex. The block of tissue and lymph nodes is removed, after which they proceed to the iliac lymphadenectomy. Such an operation technique helps to reduce the duration of scarring, reduce the likelihood of infection entering the wound, and optimize the aesthetic appearance of the postoperative area. [6]
• Retroperitoneal lymphadenectomy involves removing the retroperitoneal nodes of the lymphatic system. Abdominal surgery consists in radical excision of fatty tissue, lymph nodes in the retroperitoneal space. Possible postoperative complications can be infertility, retrograde ejaculation into the bladder. This is due to the fact that during the intervention, the postganglionic efferent sympathetic fibers, which are responsible for ejaculation, are crossed and are located paraaortally under the level of the inferior mesenteric artery abduction. The minimum metastatic foci are considered to be those whose dimensions do not exceed 20 mm: after the removal of such metastases, the likelihood of postoperative complications is reduced to a minimum.  [7]
• Iliac lymphadenectomy is performed as part of the ilio-inguinal-femoral surgery with verified metastases to the inguinal lymph nodes. Bilateral lymphadenectomy is appropriate for cancerous lesions of the penis or vulva. The classical method of Duquesne, described in the last century, is used. A long longitudinal incision is made through the middle of the inguinal ligament (with its intersection). The upper incision point is located 7 cm above the inguinal ligament, and the lower point coincides with the apex of the femoral triangle. Tissue grafts are separated according to the level of the superficial subcutaneous fascia, the subcutaneous fat layer is excised, exposing the iliac part of the abdominal wall with the femoral triangle. Next, a large subcutaneous venous vessel is isolated, ligated and crossed in the lower wound corner, the block of lymph nodes with fiber is taken inward, and the tailor's muscles outward. The removed tissues are gradually separated from the femoral vessels, raising them to the confluence zone of the large saphenous venous vessel of the femur and the femoral vein. The nervous and external oblique muscles are dissected, the peritoneum is displaced in the medial direction, the tissue and lymph nodes are separated along the iliac vessels. The iliac tissue is removed together with the femoral-inguinal tissue. The fabrics are sutured in layers. If necessary, plastic surgery of the groin area is performed. Ilio-inguinal-femoral lymphadenectomy usually involves removal of an average of eight to eleven nodes. [8]
• Para-aortic lymphadenectomy is a radical excision of the periaortic lymph nodes. The intervention is performed under general anesthesia using endovideosurgical methods. The scope of such an operation includes the removal of tissue containing lymph nodes above and below the level of the inferior mesenteric artery, up to the upper line in the area of the upper edge of the left renal vein. Para-aortic lymphadenectomy is successfully used to treat endometrial cancer. A midline laparotomy is performed above the umbilical foramen and is completed under the pubic symphysis. The use of extraperitoneal access is possible. The uterine round ligament is transected to avoid damage to the lower epigastric vessels. The parietal peritoneum is dissected, the ureter area is visualized. The funnel-pelvic ligament is transected, ligated. The peritoneum is dissected downward to the round uterine ligament along the external iliac artery. The ligament is clamped, crossed and tied. Lymphadenectomy is performed directly near the branch of the internal iliac artery. The separated tissue block, located lateral to the vasculature, is clamped and transected, and the proximal end is ligated to block lymph flow. Next, the transvasal tissue and lymph nodes are removed along the side walls of the vessels to the level of the obturator nerve. The nodes that are medial to the external iliac artery and at the entrance to the femoral canal are also subject to excision. The fat layer with lymph nodes along the external iliac vein up to the obturator fossa is also separated. After detecting the obturator nerve, the obturator fossa is visualized and the tissue is removed between the obturator nerve and the superior bladder arterial vessel. The tissue is clamped, crossed, and tied. Manipulations are performed very carefully, avoiding damage to the veins. Then the uterine artery is transected and ligated, and the lymph nodes along the internal iliac vessels are removed. The removed nodes are sent for histological examination. [9], [10]
• Lymphadenectomy for breast cancer is performed in relation to the nodes located in the armpit on the affected side. The excision can also extend to the cervical, supraclavicular, and subclavian nodes. The operation is performed in combination with the removal of the breast, in whole or in part. The surgeon makes an incision in the armpit up to 6 cm in length. Lymphadenectomy is performed directly at several levels of mutual arrangement of the nodes to the pectoralis minor muscle. The first level includes the lymph nodes located below this muscle, the second level - those that are immediately below the muscle, and the third - those located above the pectoral muscle. In the hall of the lumpectomy, the nodes of the first and second level are removed. If a mastectomy is performed - a radical resection of the mammary gland with regional lymphadenectomy, then the nodes belonging to the first, second and third levels are excised, with further plastic breast reconstruction. Such an operation takes about an hour and a half on average. [11]

To date, experts have not come to a consensus on the advisability of removing all regional lymph nodes for any oncological processes in the mammary glands. Most surgeons and mammologists believe that such a radical intervention is required only in extreme cases, when there is a clear risk of spreading metastases. The presence of such an indication is checked by performing a sentinel biopsy, or a sentinel lymph node biopsy. The sentinel nodes include those that are closest to the tumor focus - it is in them that atypical cells first of all fall and metastases form. Therefore, an intervention involving the removal of a sentinel lymph node always becomes the correct way to determine the likelihood of metastasis of a neoplasm. If the biopsy shows a negative result (abnormal cells are not found), then there is no need for a large-scale operation of lymphadenectomy with the removal of all levels of the lymph nodes. [12], [13]

• Thyroidectomy with lymphadenectomy is a standard surgery for thyroid cancer. Most often, such cancer metastasizes to the sixth (central) group of cervical lymph nodes. Experts recommend and practice thyroidectomy with simultaneous central removal of the lymph nodes for oncological formations larger than 10 mm. This approach reduces the likelihood of relapse and eliminates the need for repeated surgery in this area. Central lymphadenectomy in this case involves excision of the prelaryngeal, pair and pretracheal nodes, as well as those located along the inner surface of the carotid artery and the internal jugular vein. [14]
• Resection of the rectum with extended lymphadenectomy can be performed according to different methods, which depends mainly on the intestinal segment in which the tumor develops. If the upper third of the rectum is affected, an operation called Anterior resection is performed. If the middle third is affected, then the Low anterior operation is performed. Both the first and second interventions are carried out through the abdominal cavity. The doctor makes an incision in the abdominal wall to the left of the navel. After finding and removing the tumor focus, he connects the remaining segments of the intestine, removes nearby lymph nodes, carefully examines all tissues, and sutures. If necessary, drainage is installed (for several days). The most difficult and traumatic for the patient is the surgical removal of the lower rectal third. This intervention is called the Abdominal Perineal Resection, or Miles' operation: it involves the removal of the tumor in conjunction with the anus. In order to provide the patient with the possibility of feces, the surgeon creates a permanent colostomy. The course of the operation is usually as follows: the doctor makes an incision in the lower segment of the abdominal cavity and in the perineal region, removes the sigmoid and rectum, as well as the anus and nearby lymph nodes. In most cases, the patient has to undergo additional treatment with chemotherapy drugs. Such an intervention can last several hours (on average - 2.5 hours). [15], 
• Pancreatoduodenal lymphadenectomy is a common type of surgery for adenocarcinoma of the head of the pancreas, which has two rows of regional lymph nodes. These nodes surround the organ or are located around large nearby vessels (the abdominal aorta with branches, including the celiac trunk, superior renal and mesenteric arteries). To clarify the oncological stage of pancreatic cancer, it is recommended to remove and subject to histological diagnosis at least ten lymph nodes. After crossing the gastrocolic ligament, the surgeon performs adhesion viscerolysis in the omental bursa, mobilizes the lower edge of the gland, exposing the superior mesenteric vein. Then it crosses the right gastroepiploic vessels. The duodenum is mobilized according to the Kocher method and transected in the proximal segment. Further, parts of the hepatoduodenal ligament are mobilized, the gastroduodenal artery and the small intestine are crossed. After mobilization of the uncinate process, lymphadenectomy is performed along the superior mesenteric arterial vessel. [16]
• Lymphadenectomy for gastric cancer can be performed in three ways. The first option is a classic gastrectomy, during which a D1 lymph node dissection is performed, including the removal of paragastric lymph nodes - 1-6 row of regional nodes according to the Japanese classification. The second option is a radical gastrectomy with D2 lymph node dissection, including lymphobases localized in the direction of the branches of the celiac trunk - row of lymph nodes 7-11. The third option is represented by extended radical gastrectomy with removal of the retroperitoneal lymph nodes (12-16 row). The choice of one or another type of surgery with lymphadenectomy is directly related to the stage of stomach cancer. For example, at the first "A" stage, radical surgical intervention may involve the performance of endoscopic resection of the gastric mucosa or the use of other techniques up to the classic gastrectomy. [17]

Lymphadenectomy for colon resection

Colon surgery can be performed according to several methods, depending on which of the intestinal parts there is a tumor focus. Usually, the affected segment of the intestine is removed, as well as the lymph nodes into which the lymph flows from the tumor. This is because lymphadenectomy can reduce the risk of cancer recurrence. In addition, specialists will be able to carefully examine the removed structures, which will directly affect the nature of subsequent treatment. [18]

Surgical removal of an element of the intestine is called colectomy. If the oncological focus is removed, which is located in the right half of the colon, then they talk about right-sided hemicolectomy, and if in the left half, then about left-sided hemicolectomy. The standard resection involves the removal of up to 40 cm of the colon, although this figure largely depends on the body weight and height of the patient.

Distal resection is said if the distal two-thirds of the sigmoid colon and the upper third of the rectum are removed, and the ligation of the upper rectal and sigmoid vessels is performed. To restore the function of the rectum, an anastomosis is applied.

Left-sided hemilectomy with extended lymphadenectomy involves the removal of the left colon, which includes the sigmoid, descending, and distal half of the transverse colon. Ligation and transection of the lower vessels of the mesentery are performed, and a transversorectal anastomosis is formed.

Right-sided hemilectomy with extended lymphadenectomy includes resection of the cecum and the distal element of the ileum - about 100-150 mm. The ascending colon and proximal third of the transverse colon are also removed, ligated and transected, the ileocolon vessels, the right colon artery and the right branch of the mid-colon artery. Additionally, an ileotransverse anastomosis is formed.

There is another variant of the operation: subtotal removal with resection of the entire colon without the distal element of the sigmoid colon. In this case, all the basic vessels that provide food to the colon are separated.

Classification of lymphadenectomy

Different types of cancers require different amounts of lymphadenectomy. To denote a more complete resection, a term such as extended lymphadenectomy is used, which, in turn, is further subdivided into a number of subtypes, depending on the location of the removed lymph nodes, for example:

• aortoiliac lymphadenectomy;
• pancreatoduodenal;
• ilio-pelvic, etc.

Unlike extended, regional lymphadenectomy involves the removal of only certain lymph nodes that are in close proximity to the tumor focus.

An auxiliary term is radical lymphadenectomy, which involves the removal of all or the dominant number of lymph nodes located near the neoplasm (through the lymph flow).

Depending on the method of the operation, the removal of lymph nodes can be abdominal or laparoscopic.

Laparoscopic lymphadenectomy is performed by access through punctures in the skin, through which the surgeon inserts a special laparoscopic apparatus and instruments. This method is less traumatic and less often accompanied by the development of complications. Cavity lymphadenectomies today are performed less frequently: we are talking about the classical technique, when tissues are dissected by incision, and direct direct access is provided. After laparoscopic surgery, healing is much faster, and the risk of bleeding and wound infection is reduced.

Lymphadenectomy and lymphadenectomy

Classic radical interventions in the treatment of oncological diseases consisted in the monoblock removal of regional lymph nodes. With regard to preventive extended lymph node dissection, the term is used to describe surgical operations to remove the affected organ and areas with regional metastasis. It turns out that the name lymphadenectomy suggests a more extensive intervention, in contrast to the term lymphadenectomy, since it involves the excision of not only the lymph nodes, but also the entire section of the lymph flow, together with the surrounding subcutaneous fat layer within the fascia sheaths. Thus, it is appropriate to talk about lymphadenectomy if a regional removal of lymph nodes is performed, and about lymphadenectomy - if lymph nodes, vessels and adipose tissue are removed. 

Contraindications to the procedure

Lymphadenectomy is not prescribed if there is no possibility of complete elimination of the primary tumor. This happens if the tumor process was detected at a late stage of development. In this case, we are talking not so much about a contraindication as about the inexpediency of lymphadenectomy, since the tumor focus has already managed to spread its cells not only to the nearest lymph nodes, but also to distant tissues and organs. Even after excision of the lymph nodes, atypical structures will remain in the body, provoking the development of new cancerous (secondary) foci.

Lymphadenectomy is not performed if the patient is in serious condition - for example, suffers from serious diseases of the cardiovascular system, liver, kidneys, or he develops an acute cerebrovascular accident. Such pathologies can interfere with both the operation in general and the performance of anesthesia.

Consequences after the procedure

The most common adverse consequence after lymphadenectomy is lymphedema, a complication that is manifested by the difficulty in the outflow of lymph from the area of operation. A similar disorder develops in about every tenth patient. The main symptom is severe tissue edema. The disease has several stages of development:

1. Swelling occurs throughout the day, but disappears when the damaged area is upright. If you press with your finger, a kind of "dimple" is formed, which slowly disappears.
2. Edema is present regardless of the position of the damaged area. The skin becomes denser, the "fossa" does not appear when pressed.
3. Edema is pronounced, like "elephantiasis" (elephantiasis).

If the first stage of lymphedema is detected, it is necessary to urgently consult a doctor. This will stop the further development of pathology, and in some cases, reduce its manifestation.

In addition to edema, bleeding, which is found in the early postoperative period, can become dangerous conditions.

Complications after the procedure

In general, doctors sometimes face the following probable complications associated with lymphadenectomy:

• Loss or deterioration of sensitivity in the area of the operation, which is caused by damage (cutting) of nerve fibers. In most patients, sensitivity is restored after a certain period of time.
• Feeling of weakness, numbness, "creeping", contractures, which requires the appointment of special therapeutic exercises to reduce the feeling of discomfort.
• Lymphedema is lymphatic edema.
• Phlebitis in the area of the operation, with a possible transition to thrombophlebitis. With the timely appointment of blood thinning and anti-inflammatory drugs, such phenomena quickly disappear.
• Accession of infection, which is accompanied by pain, redness and swelling in the area of the intervention. This condition requires the appointment of antibiotic therapy.

The most common complications associated with lymphadenectomy develop in elderly patients and those with diabetes and obesity.

Care after the procedure

Immediately after lymphadenectomy, the patient is transferred to the recovery room: there he is observed until the end of the anesthesia. If everything is in order, the patient is transported to a regular ward.

If necessary, the affected area is given an elevated position. For example, after axillary lymphadenectomy, the arm is raised up from the side of the intervention, and after the removal of the inguinal lymph nodes, the patient's legs are raised.

Sometimes, during the first days after the operation, a catheter is attached to the patient to collect urine, and in some cases, a temporary or permanent colostomy bag (depending on where and to what extent the lymphadenectomy was performed).

If a drain was installed during the operation, it is removed as the condition improves (usually after a few days).

If the patient cannot feed on his own, then he is injected with nutrients intravenously. If the surgery affected the digestive system, then the patient will be informed about changes in the diet.

The duration of hospitalization is negotiated individually.

After discharge, the patient is advised not to lift or carry heavy objects, avoid wearing tight and oppressive clothing or accessories.

Rehabilitation measures are indicated for all patients who underwent lymphadenectomy. Such measures allow:

• prevent the appearance of psychological problems;
• eliminate pain;
• prevent the development of complications;
• quickly return to the usual way of life.

Standard rehabilitation techniques include exercise therapy (a special set of exercises), physiotherapy, vitamin therapy, and additional conservative treatment. The main procedures are aimed at restoring tissue nutrition and lymph flow, accelerating blood circulation and healing.

If, after lymphadenectomy, the patient has a fever, or suspicious symptoms such as chills, nausea, paroxysmal vomiting, difficulties with urine and fecal excretion, bleeding or severe pain suddenly appear, then it is necessary to urgently inform the operating surgeon about this.

Lymphomassage after surgery axillary lymphadenectomy

Lymphatic drainage massage is a physiotherapy procedure, the main purpose of which is to accelerate lymph flow. A person who performs lymphomassage should have an idea of the location of the lymphatic system and the direction of lymph movement. The procedure should not be painful, therefore stroking and light pressure are recommended as the base effects. Sessions are best done 1-2 times a week. [19]

Under the influence of this massage, the flow of lymph is stimulated, which contributes to:

• reduction of tissue edema;
• increased skin turgor;
• optimization of metabolic processes;
• improving local immunity;
• activation of blood circulation.

Contraindication to lymphomassage after lymphadenectomy can be:

• acute thrombophlebitis;
• skin diseases;
• diseases of the cardiovascular system;
• infectious pathologies.

After a session for ten minutes, the patient should lie down calmly. You can drink a glass of warm water. The result becomes noticeable, as a rule, after the first or second procedure.

Reviews

Lymphadenectomy is often a mandatory procedure that determines the effectiveness of the treatment. The intervention involves the removal of affected or suspicious lymph nodes with their further sending to the laboratory for histological examination. Reviews about the operation are mostly positive, because thanks to it it is possible to prevent the further spread of pathology, to reduce or completely eliminate the manifestations of the disease. Complications after the intervention are rare, if you follow the strict recommendations of your doctor:

• limit activity and do not load the operated part of the body;
• do not pinch or pull the affected side with items of clothing or accessories;
• avoid the leg-to-leg position (for patients who have had an inguinal lymphadenectomy).

The incidence of complications also depends on the affected area in which the lymphadenectomy is performed. For example, removal of the axillary lymph nodes in about 10% of cases leads to the development of lymphedema and skin discomfort. Removal of pelvic lymph nodes is complicated by lymphedema in only 6% of cases, and inguinal - in 15% of cases. However, much depends on the general state of health of the patient and on the qualifications of the operating doctor.