Lymph node dissection

Transcription

1 Lymph node dissection (of armpit or groin) Information for patients Dermatology

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3 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. page 3 of 12

4 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. page 4 of 12

5 Are there any complications with surgery? The common complications after this surgery are: 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. page 5 of 12

6 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. page 6 of 12

7 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. page 7 of 12

8 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. page 8 of 12

9 Is there anything I should look out for when I go home? 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 page 9 of 12

10 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. page 10 of 12

11 Contact numbers Ward F2 Royal Hallamshire Hospital (Plastic Surgery) Skin Cancer Clinical Nurse Specialists Plastic Surgery Dressing Clinic page 11 of 12

12 Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No Alternative formats can be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2016 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD5815-PIL2144 v5 Issue Date: June Review Date: June 2018