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Neck Lymphadenectomy


Medical editor Olav Jetlund MD
Otolaryngologist
Oslo University Hospital

General

The neck is separated into 6 regions to better describe the areas involved with cancer which are to be operated.

Variations of a neck lymphadenectomy

  • Radical (classical) neck lymphadenectomy in which lymph nodes are resected in regions 1-5 including the internal jugular vein, nerve XI, and the sternocleidomastoid muscle.  
  • Modified neck lymphadenectomy preserves one or more of the non-lymphatic structures to be removed by a radical neck lymphadenectomy. 
  • Selective neck lymphadenectomy in which nodes are removed within one or more regions. 
  • Elective resections in the neck are equivalent to radiation therapy in terms of results (1).

If possible, resection of the primary tumor is performed during the same surgery as the lymphadenectomy. 

Indications

  • Suspected or confirmed lymph node metastasis in the neck.

Goal

  • Removal of confirmed cancer in neck lymph nodes.

 

1. Reference: Storaker KA. Kartlegging av skulderfunksjon etter lymfeknutedisseksjon. Oslo: Rikshospitalet Universitetsklinikk, 2002


Equipment

  • Universal set
  • Basic surgery tray

Preparation

  • The operation field is shaved.
  • The surgery will take place under general anesthesia.
  • The patient will lie supine.
  • The patient's head is turned to the side and a pillow is placed under the neck to extend the neck.
  • Tracheal tube is fixed in the corner of the mouth opposite to the side of surgery. 

Implementation

  • The incision is adapted for the metastatic pattern and localization of the primary tumor.
  • The skin flaps are elevated.
  • The sternocleidomastoid muscle and jugular veins are divided caudally (not in an elective resection).
  • Fat, lymph nodes, and muscle are resected with preservation of the vagus nerve. 
  • All lymph nodes of the applicable region are removed, in this case region 5.
  • Sternocleidomastoid muscle and jugular veins are divided cranially. 
  • The lymph nodes are mainly localized along the internal jugular vein.
  • In the front, the lymph nodes in regions IA and B are removed, and the submandibular gland is removed.  
  • The specimen is marked for multiple pathologic lymph nodes. 
  • Thorough hemostasis.
  • A drain is inserted.
  • The incision is closed.

Follow-up

Observe for:

  • hematoma
  • lymph leakage (left side)
  • infection
  • skin or muscle necrosis, especially if the neck is irradiated
  • nerve injury
    • The most common is injury of nerve XI
    • Shoulder syndrome (stiffness, reduced movement, pain)
    • Lymph edema and vein stenosis in the face and neck

The drain is removed when the fluid volume is less than 20 ml/24 hours.


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