Lymph Node Removal

What is lymph node dissection?

Lymph node dissection is a type of surgery that is commonly used to treat patients with bladder cancer.1-4 In most patients, bladder cancer starts to grow in the urothelium, which is the thin layer of cells that line the inside of the bladder. In patients with bladder cancer that is muscle-invasive, the bladder cancer cells have grown from the bladder lining and into the muscle of the bladder wall. Many patients with muscle-invasive bladder cancer need to have surgery called a cystectomy. In a radical cystectomy, the surgeon removes all of the bladder and in a partial cystectomy, the surgeon removes part of the bladder.

Lymph node dissection is a procedure that is generally performed at the same time as a cystectomy for both men and women with bladder cancer. It is not usually performed as a separate surgery. After removing the patient’s bladder and other organs that may be affected by bladder cancer, the surgeon also removes lymph nodes in the patient’s pelvis. This procedure is also called a pelvic lymph node dissection (PLND).

Why is it performed?

Lymph nodes are small glands located throughout the body, including some located in the pelvis near the bladder.2 Lymph nodes are part of the body’s lymphatic system, which is a system of connected channels that transports cells, nutrients, and waste throughout the body. In patients with cancers including bladder cancer, the lymphatic system can also transport cancer cells throughout the body.

If bladder cancer cells grow into the lymph nodes in the pelvis, then the lymph system can spread bladder cancer cells to parts of the body distant from the original tumor in the bladder. This is called metastatic bladder cancer. After the surgery, healthcare providers need to analyze the patient’s pelvic lymph nodes in the laboratory to see if any cancer cells are present. This is an important part of the process of staging a patient’s bladder cancer, which helps to determine the best type of treatment after surgery.

How is it performed?

Lymph node dissection is almost always performed at the same time as a radical or partial cystectomy.2,3 The surgery can be performed through a single open incision in the abdomen. The surgeon removes either part of the bladder or the entire bladder, and potentially other nearby organs, as well as pelvic lymph nodes, through this open incision.

Surgeons can also perform the procedure using laparoscopic robot-assisted surgery, which is also called keyhole surgery. During this type of surgery, the surgeon makes several smaller incisions instead of a single open incision. Then the bladder, potentially other organs, and pelvic lymph nodes are removed through these small incisions using computer technology and robotic surgical tools. Patients who have this type of surgery may have a quicker recovery time than patients who have surgery with a single open incision.

Cystectomy with lymph node dissection is major surgery, so some patients may experience problems such as infection, bleeding, or reactions to anesthesia. Patients are carefully monitored after surgery to detect and treat these types of problems.

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