Lymph Node Surgery

The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease. The range of reported lymphedema in patient who undergo pelvic lymph node dissection is between 5-30%. However, it is important to note that the range varies widely based on several factors such as the tools to measure lymphedema or the medical comorbidities of the patient such as obesity, diabetes, hypertension, and cardiovascular disease.

There are two lymph node surgical procedures used to either identify or treat lymph node disease. The most accurate and reliable test to identify axillary disease is the sentinel lymph node biopsy. The sentinel lymph node is the "gate keeper node" of all the lymph nodes in the armpit. If cancer has spread from the breast to the nodes in the armpit, it will reliably travel to the sentinel lymph node before going to other nodes. The accuracy of this biopsy is about 99%. Women with invasive breast cancer who do not have evidence of lymph node disease should undergo a sentinel lymph node biopsy at the time of either lumpectomy or mastectomy.

If the sentinel lymph node biopsy shows evidence of cancer, the patient should discuss with their surgeon and medical oncologist whether they would benefit from removal of additional lymph nodes from the armpit. In the past, surgeons routinely removed additional lymph nodes when there was evidence of cancer in the sentinel lymph node. However, new data this year has implied that some women undergoing lumpectomy and radiation may not benefit from the removal of additional nodes. Therefore, at our institution we take these patients on a case by case basis to determine whether they would benefit from further surgery.

If patients have evidence of axillary lymph node disease prior to surgery, they should undergo a lymph node dissection at the time of either lumpectomy or mastectomy in order to remove the disease from the armpit. Traditionally, this involved the surgical removal of about 10 lymph nodes. Anytime a woman has cancer involvement of lymph nodes and has surgical removal, there is a risk of lymphedema after the surgery. Lymphedema is the chronic swelling of the arm which has no curative treatment. Other risk factors for developing lymphedema are obesity and radiation to the armpit after surgery. There are two lymph node surgical procedures used to either identify or treat lymph node disease. The most accurate and reliable test to identify axillary disease is the sentinel lymph node biopsy. The sentinel lymph node is the "gate keeper node" of all the lymph nodes in the armpit. If cancer has spread from the breast to the nodes in the armpit, it will reliably travel to the sentinel lymph node before going to other nodes. The accuracy of this biopsy is about 99%. Women with invasive breast cancer who do not have evidence of lymph node disease should undergo a sentinel lymph node biopsy at the time of either lumpectomy or mastectomy.

If the sentinel lymph node biopsy shows evidence of cancer, the patient should discuss with their surgeon and medical oncologist whether they would benefit from removal of additional lymph nodes from the armpit. In the past, surgeons routinely removed additional lymph nodes when there was evidence of cancer in the sentinel lymph node. However, new data this year has implied that some women undergoing lumpectomy and radiation may not benefit from the removal of additional nodes. Therefore, at our institution we take these patients on a case by case basis to determine whether they would benefit from further surgery.

If patients have evidence of axillary lymph node disease prior to surgery, they should undergo a lymph node dissection at the time of either lumpectomy or mastectomy in order to remove the disease from the armpit. Traditionally, this involved the surgical removal of about 10 lymph nodes. Anytime a woman has cancer involvement of lymph nodes and has surgical removal, there is a risk of lymphedema after the surgery. Lymphedema is the chronic swelling of the arm which has no curative treatment. Other risk factors for developing lymphedema are obesity and radiation to the armpit after surgery.