This information will help you understand your forthcoming treatment and contains answers to many frequently asked questions.
If you have any questions or would like further explanation, please ask one of the team.
Inguinal lymphadenectomy is an operation, performed under a general anaesthetic, to remove lymph nodes from the groins on one or both sides.
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.
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.
Lymphoedema
This can develop weeks, months or even years after cancer treatment. Signs and symptoms include swelling of the area, changes in feeling (your leg may feel heavy or stiff), skin changes and aching in the affected area.
If lymphoedema is diagnosed, you will usually be referred to a specialist lymphoedema nurse for a full assessment. Here you will learn how to manage your lymphoedema (please see the ‘Managing lymphoedema’ booklet).
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 will advise you of appropriate dressings in order to facilitate wound healing and refer you to the community nurses if required.
Wound leakage
Often these wounds become very wet, oozing clear fluid which often has a yellow or bloody tinge. The dressings may need changing regularly to keep you dry and comfortable.
Fluid loss will reduce in time and can happen regardless of when the drain is removed.
Leakage around the drain
A small amount of leakage can be dealt with using dressings, but if it is too high, a nurse may need to cut the drain shorter and place a stick-on 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)
- chest infection
- bladder problems
- muscle pains
- slow breathing (depressed respiration)
- damage to teeth, lips or tongue
- an existing medical condition getting worse
- awareness (becoming conscious during your operation).
Rare (1 in 10,000) or very rare (1 in 100,000 or less) complications
- damage to the eyes
- serious allergy to drugs
- nerve damage
- death
- equipment failure.
Deaths caused by anaesthesia are very rare, and are usually caused by a combination of four or five complications together. There are probably about five deaths for every million anaesthetics in the UK.
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.
There may be other types of treatment for your cancer, but your medical team will be suggesting this one, as in their experience they believe it to be the most appropriate for you. Your medical team will be happy to discuss the reasons for recommending this operation and any other concerns you may have.
Surveillance via clinical examination and scans
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.
Sentinel node biopsies
Dynamic sentinel lymph node biopsy is an improved method of detecting whether the nodes in the groin are involved with the tumour and can minimise the extent of groin surgery that is needed, and consequently the potential complications. A dynamic sentinel node biopsy uses a small dose of radioactive material into the sentinel lymph nodes and pictures are taken to detect the location of the sentinel node. If the result of these biopsies is negative, it means you will avoid having to undergo extensive surgery to remove the lymph nodes. An ultrasound scan of your groins would be taken prior to this operation to check for signs of abnormality of the lymph node. Fluid may be taken under ultrasound guidance to check for cancer cells at this time.
This may not be recommended if you have ‘palpable’ nodes (i.e. nodes that the doctor can feel when examining you) when you present to clinic or your ultrasound scan is positive for signs of cancer, as it only involves removing one or two nodes in each groin.
At your pre-operative appointment, the doctors will discuss the surgery with you. Following meeting with the doctors, pre- assessment appointments will also be carried out. These will involve seeing the doctor, anaesthetist, pre-admission nurse and clinical nurse practitioner.
Routine tests, for example bloods, groin ultrasounds and ECGs, may also be performed. This also gives you an opportunity to ask any questions you may have.
At your pre-assessment appointment, you will be told by the nurse or anaesthetist when to stop eating and drinking so you can fast before your operation. You should bring comfortable clothes, something to read and your medicines when you are admitted to hospital.
We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, legally we must ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternatives before they ask you to sign a consent form. If you are unsure about any aspect of your proposed treatment, please don’t hesitate to speak with a senior member of staff again.
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.
There are different types of groin dissection, but all have a similar approach. An incision is made to gain access to the lymph nodes in the groin. Skin flaps are carefully lifted up to expose the lymph nodes. All the nodes and some surrounding tissue closely connected with the nodes are removed through a long cut (incision) in the groin. The length of the scar is usually between 6cm and 12cm. The wound is closed with stitches or staples and with one or two drains (plastic tubes) left in place. One end is put in the wound under the skin and the other end is attached to a plastic bag. This drains away any blood or lymph fluid from inside the wound. The surgery usually takes two to three hours.
In a radical inguinal lymphadenectomy, all the lymph nodes seen in the groin are removed. This is a more extensive procedure and, in some patients, a small strip of muscle (sartorius muscle) is used to cover the exposed blood vessels.
In a modified inguinal lymphadenectomy, a group of lymph nodes within a set boundary are removed and analysed while you are still anaesthetised. This is called a ‘frozen section’ and involves the histopathologist having a quick review of the tissue. If there are lymph nodes involved with cancer, the surgeon will proceed to remove all the lymph nodes in the groin (radical inguinal lymphadenectomy).
All the nodes removed will be examined for cancer cells by a specialist pathologist for a final report. This will be the case even if you have undergone frozen section as it is a more detailed analysis. This examination may take several weeks, so you are not likely to receive the results until you attend your follow-up outpatient appointment.
At the end of the operation, one drain is put into the groin area. This is a narrow tube which is attached to a small plastic bottle or bag and allows blood and fluid from the operation area to drain out. The tube will be removed once the fluid output has decreased to a sufficient level.
The drains are usually removed in one to three weeks, when the drainage becomes less. It is common to be discharged home with a drain. You will be shown how to monitor the fluid levels of your drain on a daily basis, and you will also be shown how to change the drain bottle. The fluid output has to be at a consistently low level for a few days before it can be removed.
Your nurse specialist will keep in contact with you during this period and arrange for the drain to be removed in clinic. A district nurse will be organised to support you on discharge. 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.
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 blood clots forming. We encourage you to wear the anti-embolism 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 two 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 to 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.
Good care of the legs is essential at all times:
- Take extra care to avoid scratches and cuts to the leg and insect bites. If any of these happen, keep the wound clean, watch carefully for any sign of infection such as swelling, redness and marked pain, and contact your doctor.
- Avoid tight belts and socks.
- Use an electric razor for shaving.
- Do not walk barefooted.
- Wear comfortable shoes.
- Use the leg stocking (TEDs) regularly as advised.
We will ask you to a follow-up outpatient clinic at frequent intervals to monitor any side effects and to detect any possible recurrence of the cancer. You should also examine your groin area regularly every month. If you notice any swelling, please contact your team.
UCLH Macmillan Cancer Information Centre
Email: uclh.
Macmillan Cancer Support Website: www.macmillan.org.uk Macmillan Helpline
Freefone helpline on 0808 8080 000
The helpline number is also free from these mobile phone networks: 3, EE, O2, Virgin and Vodafone (when calls are made from the UK).
Cancer Research UK
Website: www.cancerresearch.org.uk
This website provides facts about cancer, including treatment choices.
Orchid – fighting male cancer Website: www.orchid-cancer.org.uk
UCLH cannot accept responsibility for information provided by other organisations.
University College at Westmoreland Street Switchboard: 020 3456 7890
For more information you can contact the Clinical Nurse Practitioners as follows:
- Sadie Molloy
- Mobile: 07852 219921
- Email: uclh.
andrologycancercns @nhs.net
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Page last updated: 30 May 2024
Review due: 31 October 2024