What is a block dissection ?
A lymph node dissection is a surgical procedure to remove all the lymph nodes within a particular basin, usually for the treatment of cancer. An axillary or inguinal block dissection involves the clearance of all the lymph nodes in the axilla/armpit or the groin respectively. It is done either when a sentinel lymph node biopsy result is positive or when there is a proven positive lymph node for cancer found in the lymph node basin.
The procedure itself is performed under a general anaesthesia and takes approximately 2 hours. You will usually need to stay in hospital for 5-7 days. At the end of the procedure, a drain will be inserted to drain any excess fluid. This is removed once drainage has subsided, but this can take a period of up to 3 weeks. In the meantime, if you are well, you can be discharged with the drain and instructions on how to look after it. There are of course risks and complications associated with the procedure but your surgeon will go through these with you during the consultation.
What are the side effects and complications of a block dissection ?
In specialist skin cancer centres, this is a routine operation and the vast majority of patients have a good result. However as with any procedure it is important to understand the potential side effects and complications associated with the general anaesthetic and the procedure itself. There is a risk of developing blood clots in your legs or lungs, associated with the surgery and stay in hospital. To reduce this risk, you will be given blood thinning injections and compression stockings to wear whilst in hospital.
In terms of the surgery itself, you will have a scar which can rarely become lumpy and stretched. There is a risk of developing wound infections and wound breakdowns. If you develop a wound infection, you will be given antibiotics. The risk of wound breakdown is higher in groin dissections, and if this occurs, then you will require dressings to help the wound heal by itself. This will be supported by our specialist team of plastic surgery nurses. In addition, there are important nerves in both areas that can be damaged or stretched. In the majority of cases, the nerves are only stretched which result in temporary sensory change or muscle weakness however it may be permanent if the nerve is damaged during surgery. There is also a risk of developing seromas in the area of surgery. A seroma is a collection of straw coloured lymph fluid that occurs due to the disruption of the lymphatic flow following surgery. Lymphoedema can also occur in the limb that has been operated on. This is a condition whereby the operated limb becomes swollen due to lymph fluid collecting within it. If this occurs, you will be referred to a lymphoedema clinic where you will be given compression stockings to wear and techniques to reduce the swelling.
What follow up will I require ?
Following your discharge, the wound is examined after a week to ensure that all is healing well. If you have been discharged with a drain, this will also be reviewed and removed when the drainage reduces to an acceptable amount. The pathology result of the block dissection usually takes 2-3 weeks and will be discussed with you in detail at your follow up appointment. This is usually at 6 weeks following the surgery. You will then require routine follow up dependent on your type of cancer.
Further information can be found here in this Block Dissection guide