Pelvic Lymph Node Dissection

What is a Pelvic Lymph Node Dissection? 

Pelvic Lymph Node Dissection (PLND) is most commonly used in bladder cancer and prostate cancer.

Pelvic Lymph Nodes are part of the Lymph System, which carries fluid, nutrients and waste material between the body tissues and the bloodstream.

Lymph Nodes are connected by a system of channels that run throughout the body. Cancer may spread through the lymph nodes to distant parts of the body.

A dissection may be performed as an;

• ELECTIVE PROCEDURE - This is the removal of the lymph nodes without any evidence that there is obvious cancer. An elective neck dissection will be considered if there is a high risk that there is microscopic (hidden or not clinically apparent) cancer in the lymph nodes (more than 20%).
• THERAPEUTIC DISSECTION- This is the removal of lymph nodes with known cancerous lymph nodes in the region based on a biopsy or a high level of suspicion based on their appearance on imaging studies.

The extent on the dissection will depend on a number of factors. Perhaps most important is the site of the primary cancer.

 

THE PROCEDURE

In bladder cancer, PELVIC LYMPH NODE DISSECTION (PLND) is performed at the time of a RADICAL CYSTECTOMY or a PARTIAL CYSTECTOMY, provides staging information and can be therapeutic.

 

PREPARATION FOR YOUR SURGERY

Before traveling to Cyprus, as part of your surgery preparation you will complete a detailed specific questionnaire, which will allow our doctors to determine your eligibility for Surgery.

Ten days prior to your arrival in Cyprus, you will receive all the necessary pre operative instructions, to prepare yourself both physically and mentally for your chosen procedure.

Before your departure your records will be reviewed thoroughly by our surgeon. This includes X-rays and a complete medical and surgical history as well as your specific issues. In addition, you may be asked to consult with a physical therapist to discuss recovery, hip rehabilitation and important precautions you must take postoperatively. The physical therapist may even give you exercises you can begin prior to your surgery in order to aid with recovery.

After traveling to Cyprus, a new set of X-rays will be taken as well as an in person physical examination. Two of the tests you may have are a CT scan and an Ultrasound.

The surgeon and anesthetist will also go through you medical and surgical issues with you. During this visit, your surgeon will discuss your procedure and answer any questions.

Preparation for the hospital

Here are a few things to keep in mind as you pack and prepare for the hospital and recuperation:

Clothing
Getting dressed in the morning helps you feel better, so be sure to bring some comfortable clothing to the hospital:

• Loose shorts or pants
• Loose tops or T-shirts
• Underwear and socks
• Short robe or pajamas
• Toiletries 

Morning of surgery

Bring all your medicines in their original containers with you to the hospital. You will meet with the anesthesiologist. This doctor will talk to you about general anesthesia. This is a controlled sleep while the surgery is being done so you will not feel any pain or remember the surgery. You will have an IV or intravenous line put in to give you fluid and medicine during your surgery. When it is time for you to go to surgery, your family will be asked to wait in the waiting area. Your doctor will talk to your family there after your surgery is done.

 

RECOVERY AFTER SURGERY

When you wake up after your surgery, you will be in the recovery room. You will stay there until you are awake and your pain is under control. Most patients return to their room after a few hours, but some will need to stay overnight for observation.

You will receive oxygen through a thin tube called a nasal cannula that rests below your nose. A nurse will be monitoring your body temperature, pulse, blood pressure, and oxygen levels.

You will have an analgesia pump device to deliver pain medication into your IV or epidural space (in your spine). You will also have compression boots on your lower legs to help your circulation. They will be taken off when you are able to walk.

You will most likely be tired and a bit sore for a few days. You may have pain not only from your incision, but also from muscle soreness in your upper back and shoulders. This is from the positioning in the operating room during the surgery. You will have liquid pain medicine in the hospital and a prescription for pain pills at home.

You may have a sore throat. This is a result of the placement of anesthesia tubes during surgery. Throat lozenges and spray usually help. 

Your neck may be slightly swollen as well. You may feel like you have a lump in your throat when you swallow. This will improve after a few days but may continue for a week or so. 

Hospital discharge and home instructions

The recovery course will depend on the extent of additional surgery and the reconstruction performed along with the neck dissection. Some surgery might require staying in the hospital for one to two weeks.

With a neck dissection alone, you should be ready to go home after two to three days—and that’s only to allow the drain output to decrease.

Before leaving the hospital, our surgeon and staff will help you adjust to recovery in every way possible. You will receive specific instructions and precautions from your surgeon and nursing staff and they will show you safe techniques of simple activities like getting in and out of bed, bathing, going to the bathroom etc.

Specific steps should be taken to minimize the risk of developing Lymphedema, a condition in which excess fluid is not properly drained from body tissues, resulting in swelling. This swelling can sometimes become severe enough to interfere with daily activity. Common sites where Lymphedema can develop are the arm or leg. Prior to being discharged, you will receive the following instructions for care of areas of the body that may be affected by lymph node removal:

• All incisions to the area should be properly cleaned, treated with an antibiotic ointment, and covered with a bandage.
• Heavy lifting should be avoided; bags should be carried on the unaffected arm.
• Tight jewelry and clothing with tight elastic bands should be avoided.
• Injections, blood draws, and blood pressure measurements should be done on the unaffected arm.
• Sunblock should be worn on the affected area to minimize the risk of sunburn.
• Steps should be taken to avoid cuts to the skin. For example, an electric razor should be used to shave the affected area; protective gloves should be worn when working with abrasive items.

You will be able to leave the hospital when you are:

• Able to eat a regular diet and drink fluids
• Passing gas or you have had a bowel movement
• Passing urine
• Not having a fever or other signs of infection
• Walk for short distances

LIFE AFTER SURGERY

These guidelines give you an overview of what you may expect as part of your care after you leave the hospital. Be sure to follow your surgeon’s discharge instructions if they are different from what is listed here:

• Most people take 2 weeks to recover. 
• You may resume most of your normal activities the day after surgery. However, wait for at least 10 days (or until your surgeon gives you permission) to engage in strenuous activities such as high-impact exercise.
• You should not drive for at least a week.

If you notice sudden swelling in your neck contact our surgeon immediately. Your calcium level may drop after surgery. This is related to disturbance of the parathyroid gland, which regulate calcium balance. This will be monitored through blood tests. You may notice numbness and tingling of your fingers or around your mouth. You will have instructions about taking calcium replacement if needed.

Medications

Your medicines: Take the medicines you were taking before surgery, unless your surgeon has made a change.

• For pain

Your surgeon will order a prescription pain medicine for you after surgery. As your pain lessens, over the counter pain medicines such as acetaminophen or ibuprofen can be used. They can also be used instead of your prescription for mild pain.

• For constipation

Prescription pain medicines can cause constipation. Your doctor may order a stool softener to prevent this. You should be back to your normal bowel routine in about 2 weeks. If the stool softener does not work, take Milk of Magnesia. If you still are not getting relief, call your surgeon.

 

FOLLOW-UP

Follow-up after surgery is extremely important and our surgeons at Salus are committed to providing all the post surgical care you need.