Inguinal lymph node dissection

An inguinal lymph node dissection is surgery to remove the lymph nodes from the groin. The lymph nodes in the groin are called inguinal lymph nodes. The groin is the area in the fold or depression where the thigh meets the belly (abdomen). This surgery is also called an inguinal lymphadenectomy or a groin dissection.

There are 2 groups of inguinal lymph nodes:

• superficial inguinal lymph nodes
• deep inguinal lymph nodes

The lymph nodes are part of the lymphatic system. The lymphatic system helps fight infections and is made up of lymph vessels, lymph fluid, lymph nodes, bone marrow and the lymphatic organs (thymus, adenoid, tonsil and spleen).

Lymph vessels are very thin tubes similar to blood vessels. They collect and move lymph fluid away from tissues into the lymph nodes. Lymph nodes are small bean-shaped organs of lymphatic tissue. The lymph fluid can carry cancer cells from where the cancer started into the lymph nodes.

Lymph fluid from tissues in the groin area drains into the lymph nodes in the groin. The lymph fluid can carry cancer cells from cancers in the groin into the inguinal lymph nodes. Lymph fluid from these lymph nodes drains into another group of lymph nodes inside the abdomen called the pelvic lymph nodes. This means that cancer from the inguinal lymph nodes can spread to the pelvic lymph nodes.

In the early stages of cancer, you cannot usually feel the lymph nodes, so doctors need to remove the lymph nodes and examine them under a microscope to find out if they contain cancer. This is most often done using a sentinel lymph node biopsy (SLNB). In more advanced stages of cancer, you may feel a lump in the groin as the inguinal lymph nodes get bigger.

Cancer of the penis, vulva, anus and skin may spread to the inguinal lymph nodes.

An inguinal lymph node dissection is done to:

• check for cancer in the lymph nodes in the groin
• remove lymph nodes that may contain cancer
• remove lymph nodes when there is a high chance that cancer will spread to them
• reduce the chance that the cancer will come back (recur)
• remove cancer that is still in the lymph nodes after radiation therapy or chemoradiation
• help doctors plan further treatment

An inguinal lymph node dissection is done under general anesthetic in a hospital operating room.

The surgeon makes a cut (incision) in the groin and removes inguinal lymph nodes that may contain cancer. Depending on how many lymph nodes are affected, the surgeon may remove only the superficial inguinal lymph nodes or both the superficial and deep inguinal lymph nodes (a complete inguinal lymph node dissection).

The lymph nodes and any other tissue removed during surgery are sent to a lab to be examined by a doctor who specializes in the causes and nature of disease (a pathologist).

After removing the lymph nodes, the surgeon creates a skin flap to cover the wound. The surgeon places one or more small tubes (drains) and closes the cut with stitches or staples. A drainage bag is attached to the end of the tube to collect fluid draining from the area. This reduces the chance of fluid building up in the tissue and improves healing. Drains are left in place for a few weeks or until there is little drainage.

People who have an inguinal lymph node dissection are usually sent home a few hours to a few days after surgery. You may be given:

• antibiotics to prevent infection
• pain-relieving medicine
• instructions on caring for and dressing the wound
• information about how to manage the drainage bag and tube
• advice on how much and which types of activity you can do after surgery
• advice on how to position lower limbs when resting
• a follow-up appointment to see the surgeon in 1–2 weeks
• information about symptoms and side effects you should report

Side effects can happen any time during, immediately after or a few days or weeks after an inguinal lymph node dissection. Sometimes late side effects develop months or years after an inguinal lymph node dissection. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Tell the healthcare team if you have these side effects or others you think may be from an inguinal lymph node dissection:

• pain and stiffness
• bruising
• signs of infection, such as pain, redness, pus, discharge or fever
• a collection of fluid under the skin (seroma) near the incision
• a buildup of lymph fluid in the soft tissues ( lymphedema) around the scrotum or in the legs
• changes in feeling or sensation (may happen if nerves are damaged)

The healthcare team may give you antibiotics to prevent or treat an infection, or they may drain a buildup of fluid. Lymphedema treatment may include massage therapy, compression garments and exercises.

Each lymph node removed is examined to see if it contains cancer.

• A negative lymph node has no cancer cells.
• A positive lymph node has cancer cells.

The pathologist’s report includes the type of cancer, the number of lymph nodes removed and the number of lymph nodes that have cancer cells. The report may also say if the cancer has grown beyond the wall of the lymph node (extranodal or extracapsular extension).

Doctors use the number of positive lymph nodes to help stage the cancer. They use the stage along with other information about the type and grade of the cancer to make treatment decisions and give a prognosis.

Depending on the result, your doctor will decide if you need more tests, any treatment or follow-up care.

In rare cases, an inguinal lymph node dissection may be done in children to stage or treat some cancers, such as melanoma or rhabdomyosarcoma.

Preparing children before a test or procedure can lower anxiety, increase cooperation and help them develop coping skills. Preparation includes explaining to children what will happen during the test, including what they will see, feel, hear, taste or smell.

Preparing a child for an inguinal lymph node dissection depends on the age and experience of the child. Find out more about helping your child cope with tests and treatments.