Download Lymph node dissection - Sheffield Teaching Hospital

Lymph node dissection
(of armpit or groin)
Information for patients
Dermatology
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Lymph node dissection
You have been advised by your plastic surgeon to have a lymph node
dissection. This leaflet aims to help you understand the procedure and
answer any questions that you may have.
Lymph node dissection is an operation to remove some or all of the
lymph nodes in either the groin or axillary (armpit) area. This can be
done on either one or both sides. Sometimes it is called a block
dissection. This is an operation which is usually carried out under
general or spinal anaesthetic.
What are lymph nodes?
Lymph nodes are part of your immune system. This helps your body to
fight infection. The lymph nodes catch bacteria, viruses, cancer cells and
other unwanted substances.
There are lymph nodes in groins, the armpits (axilla), the neck, and other
places around the body.
Sometimes cancer cells can become detached from the main cancer and
travel to the lymph nodes. They are then trapped in the lymph node and
can grow, causing swelling. When this happens, patients may be
offered surgery, radiotherapy or both.
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What are the benefits of surgery?
The aim of this treatment is to remove the cancer that is in the lymph
nodes in your groin(s) or armpit and to help prevent the cancer
spreading.
What are the risks of surgery?
There are risks to all types of surgery, including wound infection, chest
infection, thrombosis, and bleeding.
One specific risk of this surgery is that because the lymph nodes in your
groin or armpit have been removed, the normal lymph drainage is
affected. This can cause a permanent swelling due to build up of fluid
in the leg or arm on the side of the operation. This is called
lymphoedema.
We can help you to manage these symptoms, but not to make them go
away completely. If you are going to have groin surgery, the clinical
nurse specialists may measure you for stockings which you will wear
after your operation. This will help to reduce the risk of lymphoedema.
You may also have an increased risk of infection near to the operation
area.
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Are there any complications with surgery?
The common complications after this surgery are:
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Wound haematoma (collection of blood in the wound)
Seroma (collection of fluid in the wound)
Wound infection
Wound breakdown
Skin necrosis (where part of the wound loses its blood supply and
dies)
• Numbness around the operation area
• A blood clot in the veins in the legs (DVT)
• Swelling in the legs or arms or surrounding area (lymphoedema)
Possible complications will be discussed with you when you discuss the
surgery with your surgeon and before you give your consent to have the
operation. Your clinical nurse specialist will also discuss these with you
and answer any questions you or your family may have.
Is there an alternative to having this operation?
Surgery is considered to be the best way to treat cancer which has
spread to the lymph nodes. However, if surgery is not possible, or you
decide you do not want an operation, and depending upon the type of
cancer, some patients can have radiotherapy or chemotherapy.
If you decide not to have any treatment at all then the cancer in the
lymph nodes will continue to grow. This means it may spread to other
parts of the body. The enlarged lymph nodes may begin to cause
problems by pressing on nerves or blood vessels and can result in skin
ulcers in the affected area.
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What happens before I come into hospital?
You will see your surgeon at the outpatient's appointment. The surgeon
will explain the operation to you at this appointment and give you the
opportunity to ask any questions. He will ask you to sign a consent form
to say that you understand and consent to the operation that he has
described to you.
Consent
We must seek your consent for any procedure or treatment beforehand.
Staff will explain the risks, benefits and alternatives where relevant
before they ask for your consent. If you are unsure about any aspect of
the procedure or treatment proposed, please do not hesitate to ask for
more information
Pre-opeative assessment appointment
At the Pre-operative assessment clinic the nurse will assess your state of
health and will organise all the necessary tests. This may include blood
tests, urine tests, an ECG (heart tracings) and x-rays.
Our aim is to start discharge planning at this appointment. We will ask
you questions about your home situation. It is important for you to ask
for any extra help that you feel you may need when you go home, so
that plans can be set in place as soon as possible. This will help to avoid
any unnecessary delays in you going home.
What happens on the day of my operation?
You will be admitted to hospital in the morning on the day of your
operation. Your surgeon and your anaesthetist, who is the doctor who
will be giving you an anaesthetic, will come to see you and answer any
questions you may have about your operation at this time.
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What happens during the operation?
A cut is made in the groin or armpit and the lymph nodes and
surrounding tissue are removed as a block. One or two drains are put
into the wound before it is closed with stitches. These are long tubes
that are held in place in the wound with a stitch. They have a plastic
bottle attached at the other end to collect any fluid from the wound.
You will have a dressing covering your wound. The surgery usually takes
about 3 hours.
The block of tissue and lymph nodes that has been removed is sent to
the laboratory for examination under a microscope.
What happens after my operation?
You will go back to the ward from theatre. The nursing staff on the
ward will check your temperature, pulse and blood pressure regularly.
They will also check and record the drainage from your wound and
check your dressing regularly.
Will I be in pain?
Some patients have some discomfort after their operation and the
nursing staff will give you painkillers for this. It is a good idea to take the
painkillers regularly until you feel more comfortable. The nursing staff
will ask you about pain, and you should let them know if you continue
to have pain.
What happens to the drains?
The drains in your wound will be checked every day and the doctors will
make a decision when in your case, they should be taken out. Some
patients do have quite a lot of drainage for quite a long time. Your nurse
will talk to you about this in detail.
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How long will I be in hospital?
Some patients may stay in hospital for up to five days or until their drains
have been removed. The decision about when you will be able to go
home, can depend on how far away from the hospital you live and
whether you will be able to manage the wound drain at home. Your
nurse will discuss this with you.
What happens after I go home?
You will be given an appointment to be seen in the Plastic Surgery
Dressing Clinic to have your wound checked. Any further dressing will
be arranged by the nursing staff in this clinic.
You will have an appointment to see your surgeon 3-4 weeks after your
operation.
As soon as the surgeon is happy with your wound, you will be seen in
the Outpatient Clinic every three months. At this visit the Consultant will
check the area around your scars and examine the areas where you have
lymph nodes. These 3 monthly appointments will be given to you for up
to five years. Your Clinical Nurse Specialist will show you how to check
your lymph nodes yourself.
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Is there anything I should look out for when I go
home?
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More pain in or near to the wound area
Redness or more swelling in the wound area
The wound or near to your wound becomes hot to touch
More discharge from the wound or strong smell from the wound
Feeling feverish or having a raised temperature and feeling
generally unwell in yourself
• Redness or swelling or pain in your legs
If you notice any of these problems, you must contact:
Ward F2
Royal Hallamshire Hospital
• 0114 226 8321
• 0114 271 2992
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Is there anything I should do in the future to help this
recovery?
It is important to take good care of your skin and your legs or arms after
this operation.
If you have had a groin dissection, your clinical nurse specialist may have
given you pressure stockings to wear. It is important that you wear these
stockings to help to prevent excessive swelling in your affected leg.
These stockings are not suitable for all patients.
You should also try to avoid getting cuts, scratches and bites to your leg
or arm. If you do have an injury, check it regularly and look for signs of
infection, which are pain, redness and more swelling and discharge
from the wound. You should see your doctor if there is a problem. After
your operation, you should not allow anybody to take your blood
pressure or insert a needle or cannula to the leg or arm where the lymph
nodes have been removed from.
You can help to reduce the risk of damage to the skin on your arms, legs
and feet by keeping your skin clean, dry and moisturised and wearing
suitable footwear and clothing at all times. Avoid walking around in
bare feet, wear insect repellent when gardening or in warm weather
and use an electric razor for shaving to reduce the risk of nicks and cuts.
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Contact numbers
Ward F2
Royal Hallamshire Hospital (Plastic Surgery)
• 0114 226 8321
• 0114 271 2992
Skin Cancer Clinical Nurse Specialists
• 0114 271 3014
• 0114 271 1900
Plastic Surgery Dressing Clinic
• 0114 226 5147
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© Sheffield Teaching Hospitals NHS Foundation Trust 2016
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SI 2005 No.1515. Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals.
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PD5815-PIL2144 v5
Issue Date: June 2016. Review Date: June 2018