Lymph node dissection

Lymph is a colourless fluid that surrounds all body tissues. It drains from the tissues into small lymph vessels that lie between cells.

The small lymph vessels join together to form larger lymph vessels. These then pass through several lymph nodes. The lymph nodes act as filters where bacteria and harmful substances are broken down. The lymph fluid then flows through larger lymph ducts and drains into your bloodstream.

If you have a tumour, it can spread from its original site through lymphatic vessels to regional lymph nodes. A lymph node dissection aims to remove:

• the regional lymph nodes to check to see if the cancer has spread to them
• any tumour that has developed in them.

During a lymph node dissection, a surgeon will:

• cut (make an incision) in the area where the lymph nodes need to be removed
• identify and remove the targeted lymph nodes — and sometimes the surrounding fatty tissue
• close the incision with stitches or staples — they may place a small tube (drain) to stop fluid buildup.

The removed nodes are sent to a lab to check for cancer or disease.

You will usually go to hospital the day before your operation. A nurse will settle you into the ward. You will see a member of your surgical team. They will explain your operation and answer any questions you may have.

You will need to have some routine scans and tests before your operation, such as:

• blood tests
• x-rays
• an electrocardiogram (ECG)

You may have already had these at a pre-assessment appointment.

You will have a general anaesthetic for this operation (you will be asleep). Before your operation you will see an anaesthetist. You can ask them any questions you may have about your anaesthetic. There are always risks associated with having surgery. Tell your surgeons and your anaesthetist if you have any medical conditions.

You will have a scar where the lymph nodes were removed. The scar will have stitches and a dressing.

The type of stitch used depends on the surgeon's choice. If they are not dissolving stitches, you will need to have them taken out 12 to 14 days after your operation.

When you return to the ward after the surgery, the nurses will check your wound, pulse and blood pressure regularly.

You will have a drip in place. This will give you fluids through a vein and will stay in until you are eating and drinking.

It is usual to be up and about the day after your operation. Nurses will give you guidance and help.

You will have a wound drain to drain any fluid and bleeding away from the wound through a tube and into a bag. This usually stays in for 3 to 4 days, but it may need to be in longer.

You will probably go home once your wound drain comes out.

What to expect when you go home

When you leave hospital, you might be given an appointment to attend a dressing clinic. This is where a nurse will look after your wound. If you have a collection of fluid (a seroma), you might need several appointments to drain this.

You will also get an appointment to see your surgeon. It will usually be between 2 and 6 weeks after your surgery, but the timing may vary. It could be straight away so that they can monitor your wound. It is important that the surgeon continues to see you after you have left hospital.

You will feel tired after your surgery. You should take things easy for the first couple of weeks after you leave hospital. As you feel able to, build up to your normal activities.

Depending on your job and the extent of your surgery, you might be able to go back to work after 3 to 4 weeks. If your job involves lifting or heavy work, you might need more time off. Check with your surgeon or healthcare provider before returning to work. They can organise a medical certificate to cover you for your time away.

Your surgery team or healthcare provider will be able to advise you when you can drive — usually after 3 to 4 weeks. You should also check this with your insurance company. Do not drive if you are still feeling unwell.

There are some possible complications of a lymph node dissection operation. These include:

• bleeding
• wound breakdown
• infection
• fluid collection
• lymphoedema.

Bleeding after your operation can cause a collection of blood called a haematoma. Haematomas are usually removed with another operation.

Simple infections are treated with antibiotics. You may need to have antibiotics in the operating theatre.

Lymphoedema

There is a chance that your arm may swell after having a lymph node dissection. This is called lymphoedema. It happens because the flow of lymph fluid through your lymphatic vessels is disrupted after the surgery.

If this does happen, your surgeon and specialist nurses will tell you how to manage the lymphoedema. They will refer you to specialist therapists if necessary.

Lymphoedema