Lymph Node Dissection

The human body is covered by a special type of drainage system called the lymphatic drainage system. This is responsible for transporting excess fluid from the organs and tissues of the body in a fluid called lymph. Lymph fluid will contain various types of cells and substances that are no longer needed. The lymph fluid will be transported through the lymphatic drainage system and pass through small nodules or nodes that act as filters. They are responsible for filtering out these unwanted substances. Cancerous cells which break off from an organ which has cancer can also travel along this route and become trapped at the lymph nodes where they can then infiltrate a new area of the body.

Lymph Nodes

If penile cancer spreads it may affect the lymph nodes in the groin area and it may be necessary to remove these nodes using surgery. There are two methods of performing this operation;

Inguinal Lymph Node Dissection

This is a major operation and involves removing the lymph nodes from one or both sides of the groin if they are found to be or suspected of containing cancer. It will be performed under an anaesthetic and will typically take 2 – 3 hours to complete.

An incision into the groin is made and the lymph nodes are removed. A limited type of lymph node removal (Modified Lymph Node Dissection can also be performed in some instances, see below). 

After surgery

  • Painkillers will be given on a regular basis.It is important that men take painkillers regularly and not just when  pain is experienced.
  •  Blood or fluid may form around the operation site and a small plastic tube called a wound drain will be inserted near to the operation site which will allow these substances to drain out naturally and allow healing to take place. It is usually removed after 2 weeks but may need to remain in place for up to a month (see picture below).

Total Penectomy

  • It will take some time for the body to fully recover from this operation and men will need to take things easy for 4 – 6 weeks after surgery. They may need to wear anti embolism stockings (anti blood clot stockings) to protect the circulation in the legs for some time after the operation and will usually be given blood thinning medication.
  • An appointment will usually be made for a few weeks after the operation to ensure the operation site is healing satisfactorily. A community nurse  can visit men at home and check that the operation site remains clean and healthy and to detect any possible infection.
  • The wound will have dissolvable stitches which will take 4 – 6 weeks to gradually dissolve.

 Tips 

  • Always ask the healthcare team exactly what the surgery will involve and what to expect after the operation.
  • Plan ahead with regard to time off work and allowing for the healing process.
  • Try and maximise health prior to the operation by eating healthily.
  • Try to take steady exercise prior to the operation which will help keep the body healthy.
  • Try and get into the habit of moving feet when at rest and not crossing  legs. This will help prevent possible blood clots forming in the legs which can occur when mobility is reduced.

 Modified Lymph Node Dissection

The modified approach differs from the radical one (above) in that the skin incision is shorter and less nodes are removed. It is more commonly performed for disease that is not expected to have affected the lymph nodes, as a precautionary measure. However if cancer is detected in the removed lymph nodes then a full dissection may be recommended.

Follow up

It will usually take a few weeks for the results of the tissue that has been removed to be analysed by a medical scientist and a further follow up appointment will usually be made at around this time, where, the results of the operation and any further treatment that may needed discussed.

 

Complications

Lymphoedema

This is a condition that may occur following surgery to the groin area. Sometimes surgery may compromise the drainage of the lymph fluid in the pelvic area and this in turn causes lymph fluid to accumulate.This may cause the legs to swell and is called lymphoedema. Lymphoedema can cause pain and discomfort and will need specialist treatment. For more comprehensive information on lymphoedema please click here.

 

Pelvic Lymph Node Dissection

If there is evidence lymph nodes above the inguinal nodes (pelvic lymph nodes) have been affected by cancer a further operation may be
recommended to remove them. This operation is similar to inguinal lymph node removal and can be performed using
laprascopic (keyhole surgery, see picture below) or an open operation. Recovery from this operation may take slightly longer than groin surgery but in general the post operative care (above) is similar.

 

Lap

 

After surgery

  • Painkillers will be given on a regular basis.and it is important that painkillers are taken regularly and not just when pain is felt.
  • Blood or fluid can sometimesgather at the operation site and a small plastic tube(s) called a wound drain(s) will be inserted during the operation. This will allow unwanted substances to drain naturally and healing to take place. It is usually removed after 2 weeks but may need to remain in place for up to a month.
  • Men should not need to stay in hospital during this time as a community nurse can visit them at home and check that they are recovering satisfactorily.
  • It will take some time for the body to fully recover from this operation and men will need to take things easy for 4 – 6 weeks after surgery. Anti embolism stockings (anti blood clot stockings) may need to be worn to to protect the circulation in the legs for some time after the operation and a blood thinning drug will usually be prescribed.
  • The operation site will have dissolvable stitches which will take 4 – 6 weeks to gradually dissolve.
  • An appointment will usually be made a few weeks after the operation to ensure the operation site has healed . The results of the operation should be available and any further treatment which may be needed will be discussed and planned at this time.

Complications

Lymphoedema

This is a condition that may occur following surgery to the groin area. Sometimes surgery may compromise the drainage of the lymph fluid in the pelvic area and this in turn causes lymph fluid to accumulate.This may cause the legs to swell and is called lymphoedema. Lymphoedema can cause pain and discomfort and will need specialist treatment. For more comprehensive information on lymphoedema please click here.

To read personal stories of men who have been affected and treated for penile cancer please click here

Last reviewed  26/1/17 Next review July 2017

 

References available on request.

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