Cervical lymphadenectomy is the surgical procedure to remove the lymph nodes from the neck region. Lymph nodes are small glands (organs) that are part of the lymphatic system. They are involved with white blood cells or WBCs production and filtering of fluid called lymph. The lymph has a role in immunity and filtering toxins and wastes into the veins, and subsequently, out of circulation. When cancer starts to spread, it often first goes to the lymph node near it. The first lymph nodes that drain lymph fluid from the primary tumor are called sentinel lymph nodes.
A cervical lymphadenectomy may be done as a diagnostic procedure to stage cervical cancer. This procedure is also called cervical lymph node dissection or neck dissection. The procedure involves the removal and examination of the lymph nodes under a microscope. It helps the doctor to determine the stage of cancer and plan appropriate treatment.
What are the complications of cervical lymphadenectomy?
The complications of cervical lymphadenectomy include:
- Shoulder dysfunction due to the injury and damage to the surrounding nerve manifesting as significant shoulder pain, weakness in the movement of the shoulder, shoulder drop, and an abnormally prominent or winged scapula.
- Hematoma (localized collection of blood)
- Chylous fistula (leakage of lymph fluid from a lymph vessel and accumulating in the thorax)
- Facial edema (swelling in the face)
- Cerebral edema (swelling in the brain) subsequently leading to neurologic problems
- Weakness or numbness in the arms
- Blindness (rare)
- Nerve injury (such as the injury to the greater auricular nerve that provides sensations to the ear and facial nerve injury)
- Horner syndrome (characterized by drooping of the eyelid, excessive shrinking of the pupil of the eye, and the inability to sweat normally or anhidrosis)
- Difficulty in swallowing
- Injury to an important muscle (sternocleidomastoid) present on side of the neck, which may make the neck look thinner and sunken
- Bleeding
- Pain
- Poor wound healing
- Scarring
- Infections
What are the different types of cervical lymphadenectomy?
Depending on the extent of lymph nodes removal, cervical lymphadenectomy may be:
Selective neck dissection: It involves the removal of the lymph nodes from some areas of the neck, usually the areas closest to cancer.
Modified radical neck dissection: This procedure may be of different types. The surgeon may only remove most of the lymph nodes between the jawbone and collarbone on one side of your neck. In another type of modified radical neck dissection, the surgeon may additionally remove one or more of the following:
- A muscle on the side of the neck called the sternocleidomastoid muscle
- A nerve called the spinal accessory nerve
- A vein called the internal jugular vein
Radical neck dissection: It is the historical standard for cervical lymphadenectomy with which all other forms of neck dissection are compared. Radical neck dissection involves the removal of all the lymph nodes on one side of the neck. It also involves the removal of:
- A type of saliva producing gland called the submandibular gland
- The spinal accessory nerve
- The sternocleidomastoid muscle
- The internal jugular vein