Let's learn about the operation to remove the lymph nodes in the groin (Inguinal Lymph Node Dissection)?

Have you or someone you know been told by your doctor that you need to have surgery to remove a lump in your groin? You may have been a little scared when you heard the name. But don't worry, this can be a very important step in the treatment of cancer. Today, we're going to talk about this surgery called 'Inguinal Lymph Node Dissection', which is simply about removing lumps in your groin.

First, let's see what this little rascal is saying.

Okay, to put it simply, lymph nodes are small, bean-shaped structures found all over our bodies. They are part of our body's defense system, the immune system . When a fluid that travels through our body's lymphatic system passes through these nodes, it acts like a filter. These nodes trap harmful substances like germs and cancer cells.

So the inguinal lymph nodes are the nodes in the groin area, where your legs meet your lower abdomen. There are about 10 nodes that are superficial, just under the skin. The fluid that is cleansed from these nodes goes to several deeper nodes. From there, it goes to other parts of the body.

Why do you need to have this operation?

This is very important to understand. This vascular system is a major route that cancer cells use to get from one place to another. This means that cancer cells can travel through these vessels to any part of the body.

Imagine, when cancer develops somewhere in our body, those cancer cells first travel to the tissues closest to it. For example, cancers that develop in places like the genitals (penis, vaginal opening), rectum, and skin on the legs first try to spread to the tissues in the groin.

Doctors first take a small sample from the first lymph node closest to the cancer, called the sentinel lymph node , and test it (a sentinel lymph node biopsy). It's like a checkpoint. If there are no cancer cells in this first node, it's likely that there are no cancer cells in the next nodes either.

However, if the test confirms that there are cancer cells in the nodes, the nodes are completely removed through surgery. This is what we call inguinal lymph node dissection.

This can stop the cancer from spreading further. Also, knowing whether the cancer has spread to your lymph nodes will help your doctor decide what treatment is best for you.

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What are the main goals of this surgery?

There are several main reasons for performing this operation. Let's understand them clearly.

How do you prepare before the operation?

Your doctor will explain this to you in detail. Usually before the operation,

• You may be asked to stop taking certain medications (especially blood thinners) for a while.
• You will be told not to eat or drink anything for a few hours before the operation.
• You will be told in advance how many days you will have to stay in the hospital and how you will feel after you go home.

The most important thing is to follow the doctor's instructions exactly.

How is the operation performed?

These are the steps that usually happen.

1. First, an anesthesiologist will anesthetize you. This means you will be completely asleep. You will not feel anything during the operation, and you will have no memory of it afterward.

2. The surgeon then makes a small incision in the skin of the groin and carefully removes the testicles to be examined and some of the surrounding fatty tissue.

3. After the operation , a small tube (drain) is inserted to remove any excess fluid (blood, water, etc.) that may accumulate in the area.

4. The incision is then closed with stitches .

5. A bag is attached to the outside end of the tube to collect the fluid . This may be left in place for several days or weeks.

6. The removed tissue and cells are sent to a pathologist , i.e., a lab, to check for cancer cells.

Now, some hospitals are performing this operation using robotic technology (robotic surgery). The number of complications that arise from it is low.

What happens after the operation? How long will it take to recover?

You will be in the hospital for about two to four days. Maybe a little longer. It's a good idea to start walking as soon as your doctor says you can. This can help prevent things like blood clots.

When the amount of fluid coming out of the tube decreases, the doctor will remove it. It may take several weeks to fully heal. During that time, which is about 4 to 6 weeks, you should avoid things like driving or lifting weights. Your doctor will tell you exactly what you can and cannot do.

What are the risks and side effects of this?

As with any surgery, there are some risks. These are the most common complications and side effects.

What can we learn from the lab report?

The report that comes from testing the swabs sent to the lab is very important. It can reveal things like this.

• Whether or not the removed tissue contains cancer cells. If cancer cells are present, they are called "positive" or "negative."
• What is the type of cancer ?
• The grade of the cancer . This refers to how similar or different the cancer cells are from normal healthy cells.
• What is the rate of cell division (mitotic rate)?
• Margins . Whether or not there are cancer cells at the edges of the removed tissue. If there are cancer cells at the edges, it is called a positive margin, otherwise negative or clear margin.

It may take a few days or a week for this report to arrive. Once it arrives, your doctor will explain what it contains and what needs to be done next.

When should I see a doctor immediately?

If you have any of these symptoms when you go home after surgery, you should call your doctor right away . These could be signs of an infection.

• If you get a fever
• If the pain of the road to recovery is increasing
• If the incision is red, swollen, and oozing pus-like fluid

Don't delay in times like this. It's very important to seek medical advice immediately.