Pelvic lymph node dissection (PLND)

A pelvic lymph node dissection (PLND) is surgery to remove the lymph nodes from the pelvis. A PLND is also called a pelvic lymphadenectomy, ilioinguinal lymphadenectomy or deep groin dissection.

The lymph nodes in the pelvis lie along the internal, external and common iliac arteries (the main blood vessels that supply blood to the lower abdomen and trunk of the body). The 3 main groups of pelvic lymph nodes are:

• internal iliac lymph nodes
• external iliac lymph nodes
• common iliac 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 organs in the pelvis drains into the pelvic lymph nodes. The lymph fluid can carry cancer cells from these sites into the pelvic lymph nodes. Bladder and prostate cancers most commonly spread to the lymph nodes in the pelvis. Cancer may also spread to the pelvic lymph nodes from the following organs and tissues:

• seminal vesicles (the glands on either side of the prostate that produce semen)
• urethra (the tube that carries urine from the bladder to the outside of the body)
• ovaries, uterus (womb), cervix and vagina
• testicles
• penis
• lower abdominal wall
• rectum
• anus
• perineum (the area between the anus and scrotum in men or the anus and vagina in women)
• inguinal lymph nodes (lymph nodes in the groin)

A pelvic lymph node dissection is done to:

• check for cancer in the lymph nodes in the pelvis
• find out how many lymph nodes contain cancer, how much cancer has spread to them and the size of the lymph nodes
• remove lymph nodes that 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 chemotherapy
• help doctors plan further treatment

A PLND is done under general anesthetic in a hospital operating room. A PLND may be done using a wide cut (open method) or laparoscopy( laparoscopic technique).

The surgeon makes a cut (incision) in the abdomen and removes the pelvic lymph nodes. 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 places a small tube (drain) 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. The drain is left in place for a few weeks or until there is little or no drainage.

People who have a PLND are usually sent home 3–7 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
• 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 a PLND. Sometimes late side effects develop months or years after a PLND. Most side effects go away on their own or can be treated, but some may last a long time or become permanent.

During surgery, bleeding may start if there is injury to the iliac blood vessels. The surgeon will treat this complication immediately by repairing the injured blood vessels.

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

• pain, discomfort or tenderness in the lower abdomen
• constant, increasing or foul-smelling discharge
• a collection of lymph fluid (lymphocele) near the incision
• a blood clot in the leg (deep vein thrombosis or DVT)
• a buildup of lymph fluid in the soft tissues ( lymphedema) in the lower limbs

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, a PLND may be done in children to stage or treat some cancers, such as clear cell carcinoma of the cervix or vagina.

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 a PLND depends on the age and experience of the child. Find out more about helping your child cope with tests and treatments.