Lymph node surgery in the neck and vital points in it

What you will read in this article:

What is neck lymph node surgery?

Neck lymph node surgery, also known as neck dissection or cervical lymphadenectomy, is a surgery to remove lymph nodes from the neck. Lymph nodes are important parts of the body's lymphatic system that are responsible for purifying lymph fluid and removing damaged and cancerous cells. This surgery is mainly performed to check for evidence of cancer spreading to the lymph nodes; Because the lymph liquid can transfer cancer cells from the primary site of the tumor to these glands. In more advanced stages, these glands are enlarged and may be palpable as a lump in the neck. In general, the goal of this surgery is to diagnose the stage of cancer and, if necessary, to remove the involved lymph nodes for treatment. If this surgery is performed by the best thyroid surgeon, the possibility of damage to the vocal nerve is greatly reduced.

Reasons for neck lymph node surgery

Neck dissection surgery is performed for the following reasons:

Checking for cancer: To determine if cancer cells have spread to the lymph nodes in the neck.
Removal of involved lymph nodes: To remove lymph nodes that may contain cancer cells.
Preventing the spread of cancer: To remove lymph nodes when there is a high possibility of cancer spreading to them.
Decreasing the chance of cancer returning (recurrence): To reduce the chance of cancer returning in the future.
Removal of cancer remnants: To remove cancers that have remained in the lymph nodes after radiation therapy or chemotherapy.
Planning for further treatments: To help doctors make decisions and plan for further treatment steps.

Who needs neck lymph node surgery?

Neck dissection surgery is performed for people who have been diagnosed with cancer in their neck lymph nodes or are suspected of spreading it. The most common types of cancer that may spread to the lymph nodes of the neck are:

Head and neck squamous cell carcinoma
Skin cancer, including melanoma
Thyroid cancer
Salivary gland cancer

How to diagnose the need for neck lymph node surgery

Determining whether or not you need lymph node surgery is a multi-step process that begins with a clinical examination and leads to specialized investigations.

First, the doctor will review your medical records and perform a physical examination to evaluate the condition, size, and tissue of the lymph nodes in the neck.
If the glands look abnormal (eg, swollen, hard, or painful), the next step is imaging. Methods such as ultrasound, CT scan, or MRI are used to obtain a more detailed view of the lymph nodes and surrounding tissues.
If the imaging results cannot definitively determine the condition of the glands, the doctor will order a biopsy. In this method, a small part of the lymph node tissue is removed and sent to the laboratory for microscopic examination. This is the most accurate way to confirm the presence of cancer cells or the cause of infection.
Finally, if the biopsy results confirm the presence of cancer or show that the possibility of its spread to the lymph nodes is very high, surgery is suggested as one of the main treatment options or as part of the process of diagnosing the extent of cancer (determining the stage of cancer) and helping to choose the exact treatment method.

Types of lymph node surgery

The amount of tissue and the number of lymph nodes removed depends on how far the cancer has spread. There are three main types of neck dissection surgery:

Radical neck dissection:

In this type of lymph node surgery, all the tissues on one side of the neck (from the jawbone to the collarbone) are removed. Muscles, nerves, salivary gland and main blood vessels are also removed in this area.

Radical dissectionRevised Neck:

This method is the most common type of neck dissection. In this surgery, all the lymph nodes are removed; But less tissue is removed than radical dissection. This procedure may also spare the neck nerves and sometimes blood vessels and muscles.

Selective neck dissection:

If the cancer has not spread too far, fewer lymph nodes are removed. In this type of surgery, the muscles, nerves and blood vessels of the neck may also be preserved.

How to perform lymph node surgery

This operation is performed in the hospital and under general anesthesia, and you will not feel any pain during the surgery. Lymph node surgery can be performed by open or laparoscopic method. Which method the surgeon uses depends on the type of operation and your general condition. In open surgery, the surgeon opens the desired area by making a single incision. But in laparoscopic surgery, the surgeon uses several small incisions; A camera is inserted through one of the incisions and surgical instruments are inserted through the other incisions.

The surgeon removes the desired lymph nodes and sometimes some of the surrounding tissue. These samples are then sent to a laboratory to be examined and analyzed for cancer cells. Before closing the surgical site, a tube connected to a bag (called a drain) is inserted into the wound. This drain helps prevent fluid accumulation in the tissues and remains in place for several days after the operation.

The need to preserve the vocal nerve and parathyroid glands during removal of lymph nodes

According to Dr. Seyed Ahmed Fanai, it is very necessary to maintain the health of the recurrent laryngeal nerve (RLN) and parathyroid glands during the removal of central lymph nodes (central lymphadenectomy). The surgeon must carefully follow and identify the exact path of the recurrent laryngeal nerve in the surgical area and completely separate it from the lymph nodes and central tissues.

In many cases, the nerve may be hidden deep under the lymph nodes; Therefore, if the nerve is not accurately identified and not exposed directly, there is a possibility that it may be unintentionally damaged, stretched or even cut during tissue removal. No lymph node should be removed without confirming the exact location of the nerve.

Also, in order to guarantee the correct function and prevent hidden injuries, it is necessary to evaluate both the recurrent laryngeal nerve (in the proximal and distal parts) and the vagus nerve at the end of the operation using a neurometer to ensure the accuracy of their function.

Convalescence period after neck lymph node surgery

The duration of recovery after lymph node surgery varies from person to person and depends on factors such as the extent of the operation, the number of removed nodes, and the patient's general health condition. In general, initial recovery is achieved within 2 to 4 weeks after surgery.

During this period, it is normal to feel pain, swelling and stiffness in the neck area. These symptoms gradually decrease with regular use of painkillers and strict adherence to the doctor's instructions. In some cases, when surgery is combined with complementary treatments such as chemotherapy or radiation therapy, the complete healing process may take several months.

Preparations before lymph node surgery

Completely share your medical information with your doctor.
If you are pregnant or think you might be pregnant, be sure to discuss this with your surgeon.
Tell your doctor the names of all medicines you take (including over-the-counter medicines, vitamins, supplements, and herbal medicines).
5 to 7 days before surgery (according to the doctor's advice), stop taking blood thinners such as aspirin, ibuprofen, naproxen, warfarin and clopidogrel.
Ask your doctor about taking permitted medications on the day of surgery.
Avoid eating and drinking any food or liquids from midnight before surgery.
Drink the medicines that the doctor has allowed with a small amount of water.

Care after lymph node surgery

After the surgery, you will be transferred to the recovery room to regain consciousness.
The head of your bed is held at a slight angle.
A tube (angiocette) is placed into your vein to receive fluids and nutrition.
You may not be able to eat or drink anything for the first 24 hours.
Painkillers and antibiotics will be injected into you.
A drain tube is removed from your neck to drain fluids.
On the same day of surgery, the nurses will help you get out of bed and move a little.
You may start physical therapy right away or after discharge from the hospital.

Discharge and follow-up:

Most patients are discharged from the hospital after 2-3 days.
You should visit your surgeon for a follow-up examination 7 to 10 days after surgery.

Paying attention to the correct care points during the recovery period after surgery plays a key role in accelerating the recovery process and preventing possible complications.

Wound care:

If using suture adhesive, keep the surgical area clean and dry. Do not touch the glue and let it peel off by itself after a few days.
If you have stitches, apply antibiotic ointment (such as bacitracin) and Vaseline to the stitches twice a day until they are removed.

Dern care:

A drain is a small tube placed in your neck to drain excess fluid. Nurses take care of it in the hospital.
If you are discharged with a drain, you should empty it three times a day and measure the amount of liquid. The nurses will teach you how to do this.
When the amount of liquid drained within 24 hours reaches a certain limit (usually less than 25 cc), you should contact your doctor to remove it.

Feeding and ingestion:

After surgery, swallowing may be difficult due to swelling and stiffness of the neck, which is normal.
First start with clear liquids and gradually reach solid foods.
For some people, it is helpful to tilt the chin toward the chest when swallowing or eating thick foods such as applesauce.
Pay attention to signs of food or liquid entering the respiratory tract (such as severe coughing when swallowing); Because this condition can lead to serious problems such as aspiration pneumonia.

Physical activity and rest:

In the first weeks after surgery, avoid lifting heavy objects and doing high-pressure activities that put pressure on the neck.
Start light and short walks daily. This helps improve blood flow and prevent blood clots; But don't tire yourself.
Your doctor may prescribe physical therapy exercises to restore flexibility and normal range of motion of your neck and shoulder.

How to sleep:

When sleeping, put your head a little higher than the body. Use several pillows for this. This situation helps to reduce the swelling in the surgical area.
Try not to sleep on the side of the surgery to avoid any pressure on the wound site.

Pain management:

Take the painkillers prescribed by the doctor regularly and at specified times; Even if you don't feel much pain. This will help control the pain and prevent it from becoming severe.
If your pain does not decrease with medication or becomes more severe, be sure to inform your doctor.

Complications and warning signs of lymph node surgery

Choosing an expert and experienced surgeon plays a key role in the success of surgery and minimizing possible risks. A skilled and trained surgeon, by mastering the complex anatomy of the neck and using advanced equipment, performs the operation more accurately and avoids damage to nerves, blood vessels and other nearby vital tissues.

Dr. Seyed Ahmad Fanai, thyroid and parathyroid surgeon, performs surgery to remove lymph nodes in the neck with the most up-to-date equipment such as neurometer, Harmony, etc. Along with the skill of the surgeon, these devices prevent damage to the vocal nerves and larynx and minimize the complications of surgery.

If you see any of the following side effects, be sure to contact your doctor:

Symptoms related to wound infection such as pain, redness, purulent discharge or fever
Nerve damage that can lead to numbness, weakness, or changes in shoulder movements.
Damage to nearby vessels or organs
Blood clotting
Unbearable pain and severe stiffness
bruising
Fluid accumulation (seroma) under the skin of the neck
Swelling caused by accumulation of lymphatic fluid (lymphedema) in soft tissues
Change in the shape of the neck

Last word

Neck lymph node surgery is a sensitive and specialized operation that is used as part of a comprehensive treatment plan to deal with cancer. This surgery, which has different types, is performed with the aim of removing the involved lymph nodes and preventing the spread of the disease. Choosing a skilled and experienced surgeon and carefully observing pre- and post-operative care points play a vital role in the success of the treatment and achieving the best possible result.

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