Lymph Node Surgery in Ankara, Turkey

Lymph node excision is the surgical removal of suspicious lymph nodes for diagnostic or therapeutic purposes. It plays an important role in evaluating infections, cancer, or immune system disorders and helps establish a definitive diagnosis.

Excisional biopsy for lymph node evaluation can be performed under local or general anesthesia. The surgical approach varies depending on the location of the node and is usually planned as a short procedure. The patient may be discharged on the same day.

After lymph node excision, the removed tissue is analyzed under a microscope through pathological examination. This analysis provides definitive results for detecting cancer cells, identifying infectious causes, or determining immune system abnormalities.

Following lymph node removal, temporary pain, swelling, or bruising may occur in the area. Although complication rates are low, issues such as infection or delayed wound healing can rarely develop. Regular follow-up is recommended.

You can contact Prof. Dr. Ebru Soy, one of the doctors performing Lymph Node Surgery in Ankara, to get information about Lymph Node Surgery prices, the process, and the hospital where Lymph Node Surgery is performed.

What is a lymph node?

A lymph node is a small, bean-shaped structure that is part of the immune system and helps defend against infections by filtering lymph fluid. They are found throughout the body, especially in the neck, armpits, and groin. Lymph nodes may enlarge in conditions such as infection, inflammation, or cancer. From a diagnostic perspective, the size, tenderness, and location of enlarged lymph nodes are important.

Why is a lymph node removed?

The reason for removing lymph nodes is generally grouped under two main headings. One is like collecting evidence to solve a mystery; the other is a strategic move to stop the enemy’s advance.

• For Diagnosis (Excisional Biopsy)

Sometimes we notice a persistent swelling—especially in areas such as the neck, armpit, or groin—that does not go away for weeks and has an unclear cause. In such cases, removing that lymph node may be necessary to determine what it is. This is called an excisional biopsy. It is particularly used when small samples obtained with a needle (fine-needle aspiration or core biopsy) are not sufficient for a definitive diagnosis.

You can think of this as trying to understand what is in a room. A needle biopsy is like looking through a keyhole—you may see a corner, but you can miss the full picture. Removing the entire lymph node is like opening the door and entering the room. The pathologist can examine the complete “architecture” of the node—how everything is arranged—to establish the most accurate diagnosis. This is considered the “gold standard” especially in diagnosing certain blood cancers such as lymphoma. The goal here is not treatment, but accurate diagnosis.

• For Treatment (Therapeutic Lymphadenectomy)

In a patient with a confirmed cancer diagnosis, the purpose is different. The goal is to clear pathways through which cancer may spread. After separating from the primary tumor, cancer cells often travel first to the nearest lymph nodes. Removing these nodes helps prevent local recurrence and may help reduce the chance of further spread to distant parts of the body. At the same time, examining the removed lymph nodes for cancer cells clarifies the stage of the disease. This staging is one of the most important factors determining whether additional treatments such as chemotherapy or radiotherapy are needed.

What is the role of lymph node removal in cancer treatment?

Lymph node operations form two strategic pillars of the fight against cancer: understanding how far the disease has progressed (staging) and stopping its progression (regional control).

• Determining the Stage of Cancer

When planning cancer treatment, the most important question is how far the disease has spread. The “N” in the international TNM staging system answers this question. Lymph node status provides one of the strongest predictors of disease course. If lymph nodes are clear on pathology, it is a good sign that the cancer is likely confined to the organ of origin. If cancer cells are found in lymph nodes, it suggests an increased risk of systemic (whole-body) spread. This critical information helps determine whether postoperative treatments such as chemotherapy, targeted therapies, or radiotherapy are necessary. In short, lymph node status draws the roadmap of the treatment plan.

• Regional Disease Control

Another key goal is achieving regional control. Cancerous lymph nodes can enlarge over time, merge into hard masses, adhere to the skin causing wounds, or press on nearby nerves leading to persistent pain. Lymphadenectomy helps prevent these potential issues before they develop. By removing involved nodes, it reduces the risk of recurrence in that region and helps protect the patient’s future quality of life. Even with effective systemic therapies, the comfort and safety provided by regional control remain an essential part of treatment.

How has sentinel lymph node biopsy changed treatment?

One of the biggest revolutions in surgical oncology in recent years is the sentinel lymph node biopsy (SLNB) technique. Especially in diseases such as breast cancer and melanoma, this method has fundamentally changed the treatment approach and put the philosophy of “less is actually more” into practice.

To understand the sentinel node concept, imagine the roads leading to a fortress. Cancer cells leaving the tumor typically stop first at a “sentinel” checkpoint before spreading through all lymphatic pathways. This first checkpoint is the sentinel lymph node. The logic is simple: if there is no problem at this first checkpoint, the remainder of the route is highly likely to be clear. SLNB aims to find and remove only this first node. If pathology shows the node is free of cancer, the dozens of remaining lymph nodes are left untouched.

The biggest gain is protecting patients from unnecessary major surgery and from the most feared side effect—lymphedema (permanent swelling of an arm or leg). In the past, to eliminate the risk of lymph node involvement, all nodes in that region (for example, 15–20 axillary nodes) were removed, causing lifelong swelling in many patients. Thanks to SLNB, we now know that most patients do not need such radical surgery.

What if cancer cells are found in the sentinel node? In the past, this automatically meant removing the remaining nodes. However, modern medicine has gone a step further. Large studies have shown that in some patients with only a small amount of cancer in the sentinel node who will also receive treatments such as radiotherapy, removing the remaining nodes does not improve overall survival. This has ushered in an era of even more personalized surgery and greater protection from unnecessary morbidity.

What evaluations are done before lymph node surgery?

Successful lymph node surgery requires careful preparation and detailed planning. Physical examination alone is not enough; we use advanced imaging to determine the roadmap. The main methods used preoperatively include:

• Ultrasound (US)
• Fine-Needle Aspiration Biopsy (FNAB)
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET/CT)

Ultrasound is like the surgeon’s eyes for superficial areas such as the neck, armpit, and groin. It shows the structure, shape, size, and suspicious features of lymph nodes with high accuracy. A major advantage is allowing immediate needle biopsy of a suspicious node under guidance. If the biopsy is positive, the surgical plan may change entirely—sometimes sentinel node biopsy is skipped in favor of a therapeutic procedure, or the patient may be directed to preoperative chemotherapy.

For deeper lymph nodes (such as inside the abdomen or chest) or to assess whether disease has spread throughout the body, CT, MRI, or PET/CT are used. CT and MRI provide detailed anatomical mapping. PET/CT, however, is often the star: it shows how a special sugar molecule taken into the body is absorbed by cancer cells. Because cancer cells are highly active, they take up more sugar and appear as bright spots. PET/CT can also reveal distant spread to organs such as the liver or bones in a single scan. If PET/CT shows distant metastasis, it may spare the patient a large lymph node surgery that would not provide benefit and shift treatment directly to systemic therapies.

How is the sentinel lymph node found during surgery?

Finding the sentinel node is like a treasure hunt, and we have two main tools for this hunt: a radioactive tracer and a blue dye.

Before surgery, a very low-dose radioactive substance (technetium-99m) is injected near the tumor area. It enters lymphatic channels, follows the same route cancer cells would take, and accumulates in the sentinel node. A preoperative scan called lymphoscintigraphy maps where the tracer collects—like a GPS that tells the surgeon where to look.

When surgery begins, the second marker is used: a blue dye injected near the tumor. It flows into the lymphatic channels and stains the sentinel node (and connecting vessels) blue within minutes. The surgeon uses a gamma probe (a pen-like device) that detects radioactivity and also visually searches for the blue-stained tissue. The gamma probe “beeps” more strongly as it approaches the radioactive node—like a “warmer, warmer” signal. Typically, the node that is both “hot” (radioactive) and “blue” is considered the sentinel node and is removed for pathology. This dual technique raises detection rates to over 98%.

Why is the pathology report so important after lymph node surgery?

Lymph nodes removed during surgery are sent for pathological evaluation, the most critical step in treatment. The pathology report does not only say “cancer present” or “absent”—it provides invaluable details about the character and extent of the disease. This report becomes the definitive roadmap for the next treatment steps.

One of the key elements is how many lymph nodes contain cancer cells. In cancers such as breast or colon cancer, a higher number of positive nodes generally indicates a higher risk of recurrence. This information helps determine whether chemotherapy is needed and how intensive it should be.

Another important concept is the “lymph node ratio” (LNR), calculated by dividing the number of positive nodes by the total number of nodes removed. For example, finding cancer in 1 of 20 nodes (LNR = 0.05) is not the same as finding cancer in 1 of 5 nodes (LNR = 0.20). Even though both have one positive node, the second scenario may indicate a higher risk. This ratio also reflects how comprehensive the surgery was. If an insufficient number of nodes are removed (for example, at least 12 nodes are targeted in colon cancer), a patient who actually has positive nodes might be incorrectly reported as node-negative—this “stage migration” can deprive the patient of a life-saving treatment. Therefore, the surgeon’s role is to remove an oncologically adequate number of lymph nodes.

What are the possible risks and complications of lymph node surgeries?

Like any surgery, lymph node dissections have potential risks and side effects. What these risks are—and how often they occur—depends on the anatomical region involved.

Lymphedema

This is the best-known and most concerning long-term complication. When part of the lymph system is removed or damaged, lymph fluid can accumulate in an arm or leg and cause permanent swelling. There is no definitive cure, so management focuses on risk reduction and control. The risk is directly affected by how many nodes are removed and whether radiotherapy is applied to that region. Sentinel node biopsy has significantly reduced this risk compared with full dissections. Patients at risk of lymphedema should follow lifelong precautions such as:

• Protecting the affected arm/leg from cuts, burns, insect bites, and other trauma
• Avoiding blood draws, injections, and blood pressure measurements on that limb
• Keeping the skin moisturized to help prevent infections
• Avoiding tight clothing, watches, or jewelry
• Maintaining a healthy body weight

Seroma

This is the accumulation of lymph fluid and serum in the surgical cavity. It is common after axillary and groin procedures. It is often reabsorbed over time, but large or uncomfortable seromas may need to be drained with a needle. Postoperative drains are used to reduce seroma formation.

Nerve Injury

Sensory or motor nerves passing through the surgical field may be at risk during dissection.

• Axillary Surgery: Persistent numbness on the inner upper arm (very common and expected), a “winged scapula,” or weakness pulling the arm backward.
• Neck Surgery: Shoulder droop and pain (the most significant functional issue), drooping at the corner of the lower lip, or tongue numbness.
• Groin Surgery: Numbness on the front of the thigh is common.

Some nerve injuries may be temporary, while others can result in permanent functional loss. For this reason, postoperative physical therapy and rehabilitation are crucial to preserve function at the highest level possible.