Inguinal lymphadenectomy

The lymphatic system is a part of the body’s immune system which helps to fight infection. It also helps to remove excess fluid from the body. The lymphatic system consists of vessels similar to veins which carry the lymph around the body. Along its course are groups of nodes or glands. After passing through various nodes, the lymph is finally delivered into the blood stream.

• The lymph nodes usually lie in groups in the neck, armpit and groin. They are also present inside the chest and abdomen. Each group tends to receive lymph from a specific area of the body. The lymph nodes in the groin receive the lymph from the lower half of the body.
• Sometimes cancer cells can get detached from the main cancer and are carried in the lymph and settle in the lymph nodes. They can grow there, causing swelling. The doctor will have previously examined you to assess if the lymph nodes are affected. You may have had to undergo special investigations such as fine needle aspiration (FNA) cytology, an ultrasound scan and a CT scan.
• If the lymph nodes are affected by cancer, they are treated with surgery. Sometimes radiotherapy or chemotherapy may be needed. During surgery, the surgeon removes all the nodes from the groin, along with some surrounding tissue. These nodes are sent for examination under microscope and the results are then discussed with you at your follow-up clinic appointment.

There are some risks in having this treatment, which you should consider before consenting for the operation. These potential complications are rare. You should discuss these with your doctor when you visit the hospital.

All operations carry risks, such as bleeding and infection, and these risks will be explained to you in detail before you sign the consent form.

Problems that may occur after groin dissection include:

Pain

You may experience some discomfort following your operation. Please take your painkillers regularly as prescribed on the packet. Do not exceed the stated dose. This discomfort will settle down after a few weeks, but if it does not, please contact your doctor.

Bleeding

You should not experience any major bleeding. It is normal for there to be a spot of blood on the dressing. This can be stopped by applying pressure to the area. Use a clean piece of gauze and press firmly on the wound site for about 10 minutes. If the bleeding does not stop, seek medical advice.

Numbness

Some of this goes away after several months, but the feeling may not return to normal. This may be irritating, but it seldom causes a major problem for most patients.

Inflammation (redness of the skin)

This is a normal and harmless part of the wound healing process and can be confused with infection. It can be accompanied by warmth of the skin and also discomfort or pain, which can be managed with regular painkillers.

Wound breakdown

Your wound may slightly ‘open’ following surgery. Your nurse specialist will advise the appropriate dressings to facilitate wound healing. This will be closely monitored whilst inpatient, dressings may need changing regularly to keep you dry and comfortable whilst in hospital. You will be referred to the community nurses if required upon discharge.

Swelling

This is usually temporary and gradually disappears. Surgery to remove the lymph nodes interferes with the lymphatic system, leading to a build-up of excess fluid in the affected area (known as a seroma). A seroma can feel soft and spongy or hard to touch. It is often uncomfortable, but most need no further treatment and will go in time. If the seroma is too painful, puts pressure on the wound, is red or hot, or you feel unwell, contact your nurse specialist. You may need antibiotics or drainage of the seroma (aspiration), which is a painless procedure and can be performed in the clinic setting.

Genital swelling

You may experience some swelling of the scrotum and penis following your surgery. Supportive underwear such as a scrotal support will help to control this. For more long term genital/pelvic swelling, cycling shorts are advisable following assessment.

Lymphoedema

This type is known as secondary lymphoedema caused by the surgical removal of lymph node from the groins for cancer treatment. As mentioned previously the removal of the nodes interferes with the lymphatic system, therefore swelling occurs as fluid accumulates within the tissues

Signs and symptoms include:

• Increased swelling of the area (legs)
• changes in feeling (your leg may feel heavy or stiff difficult to move),
• skin changes – (firm, more thickened and feeling tight)
• lymphorrhoea ( leakage of lymph fluid on surface of skin)
• infection (more risk of cellulitis)

This can occur weeks, months, or years after your cancer treatment. Your CNS will advise you on preventative measures like keeping active i.e. walking, elevating of legs, wearing loss clothing (non-restricting i.e. waist belts) and good skin care. You will also be sign posted to lymphoedema websites for further information.

Post op suction drains (redivac)

This drain is inserted at the end of your operation to ensure adequate drainage of blood and fluid from the operation. You may acquire some leakage around the drain in time as drains tend to stay from one to several weeks.

This can be dealt with using dressings but if it is too high, your nurse specialist may need to cut the drain shorter and place a wound bag over the top of the drain site to collect the fluid.

There are a number of issues that affect the chances of suffering complications, including: age, weight, lifestyle issues and your general state of health. Your anaesthetist and/or your surgeon can give further details. The information below on risks is provided by the Royal College of Anaesthetists:

Very common (1 in 10) and common (1 in 100) side effects

• feeling sick and vomiting after surgery
• sore throat
• dizziness, blurred vision
• headache
• itching
• aches, pains and backache
• pain during injection of drugs
• bruising and soreness
• confusion or memory loss.

Uncommon side effects and complications (1 in 1,000)

This is not something we would recommend. Without treatment, the cancer in the lymph nodes will continue to grow and it will spread to other parts of the body. The skin in this area may break down, resulting in an open, painful wound with infection and bleeding.

An inguinal lymphadenectomy is usually performed at a second stage following surgery to remove the original or primary tumour from around the penis. Occasionally, the groin nodes will be removed at the same time as your primary surgery. This is more common where groin nodes are palpable/prominent at the time of presentation/first appointment.

Your team may request that you remain in bed for up to 48 hours after your operation and instructions will be given with regards to how your leg should be positioned.

As mentioned previously at the end of the operation a closed post suction drain is inserted into the groin area. This is a narrow tube sutured to skin which is attached to a closed plastic bottle allows blood and fluid from the operation area to drain out. Drains can stay from one to several weeks – they need to be below 50mls for 2 consecutive days before they can be removed – mobility (walking) encourages good drainage. Often you will be discharged with drains therefore you will be educated on how to manage the drains at home by your nurse specialist and ward team, to ensure you are competent before discharge. You and will receive a weekly follow up with your nurse specialist to review drains and wounds. You will be given a bag

to hold the drain bottle, which is worn across the body to enable you to mobilise more effectively.

You will be given a blood thinning injection to prevent blood clots and you will be required to wear anti embolism stockings which help to encourage leg circulation and help stop you getting blood clots forming. We encourage you to wear the antiembolism stockings for 28 days after surgery. We will also teach you how to administer the blood thinning injection at home once per day for 28 days after surgery.

You will have a urethral catheter (a tube up your water pipe into the bladder to drain urine) in place which will be removed when you are allowed to mobilise.

For the first two days your wound will be covered with a simple dressing. Your team will review the wound on day 2 and will advise the nursing team with regards to future dressings or whether the area can be left exposed.

There will be some pain after the operation. We will give you painkillers both when you are in hospital and to take home with you when you are discharged. The pain will gradually get less over the first week. You will also be given some antibiotics to take home.

The cut in your groin is closed with stitches or skin clips, which are removed about 10-14 days after the operation. You may have these removed in clinic. Should we request removal via your local GP service, a referral will be made on your behalf.