Surgery to remove neck lymph nodes (neck dissection)

Surgery to remove lymph nodes in the neck is called a neck dissection. Lymph nodes are also called lymph glands. They are part of the lymphatic system.

When you might have a neck dissection

You might have surgery to remove lymph nodes in your neck. This is usually if there is a chance that the cancer might have spread there.

The lymph nodes are part of the lymphatic system. Cancer cells can first travel to the nearest lymph nodes if they break away from a tumour. So, your doctor removes them and checks for cancer cells.

Diagram showing the lymph nodes in the head and neck

What happens?

You have the operation while you are asleep (under general anaesthetic).

You might need to have lymph nodes removed from one side of your neck or from both sides. Removing the lymph nodes reduces the chance of the cancer spreading or coming back.

There are different types of neck dissection, including:

partial or selective neck dissection
modified radical neck dissection and
radical neck dissection

How you have a neck dissection

Your doctor will check that you are fit and well enough for a general anaesthetic. They will talk to you about the operation and answer any questions you might have. The operation can be done in several ways. This includes:

Partial or selective neck dissection

If you have a partial or selective neck dissection, your surgeon removes some of the lymph nodes in one side of your neck.

Modified radical neck dissection

There are 3 types of modified radical neck dissection.

With one type your surgeon removes most of the lymph nodes between your jawbone and collarbone on one side of your neck.

With the other 2 types your surgeon also needs to remove one or more of the following structures:

a muscle at the side of your neck called the sternocleidomastoid
a nerve called the accessory nerve
a vein called the internal jugular vein

Diagram showing the muscle, nerve and blood vessel sometimes removed with a lymph node dissection of the neck

Radical neck dissection

If you have a radical neck dissection, your surgeon removes most of the nodes on one side of your neck. They also remove:

all of the muscle on that side of your neck (the sternocleidomastoid muscle)
the accessory nerve
the internal jugular vein

After surgery

You usually stay in hospital for 2 to 5 days. It can take a few months to fully recover from the operation.

Problems after surgery

The side effects depend on which structures have been removed or disturbed during surgery.

Shoulder stiffness and arm weakness

The accessory nerve controls shoulder movement. So, if you have this removed, your shoulder will be stiffer and more difficult to move. If you have a partial or modified neck dissection, the weakness in your arm usually lasts only a few months. But if you have your accessory nerve removed, the damage is permanent.

Your doctor will refer you to a physiotherapist. They will show you some exercises to help improve the movement in your neck and shoulder. You must do these exercises regularly.

Speak to your doctor if you still have problems with pain and movement a year after surgery. They may look into whether a further operation to reconstruct some of the muscles might help. But this isn't suitable for everyone.

Pain

You may also have some pain. Taking painkillers can help. Physiotherapy exercises can also reduce pain. Your doctor can refer you to a pain clinic if the pain continues or is not controlled with painkillers.

A thinner, shrunken and stiff neck

Your neck will look thinner and shrunken if you have had the sternocleidomastoid muscle removed.

Your neck might be stiff after the operation, and you might need physiotherapy.

Swelling (lymphoedema)

After surgery to remove some or all of the lymph nodes in your neck, the area can be swollen. This can be due to general swelling around the surgical wound. This usually goes down within a couple of weeks. But it can also be a sign of lymphedema if this swelling doesn’t go away.

Lymphoedema means a build up of lymph fluid that causes swelling. It can develop because surgery interferes with the normal flow of lymph in the lymphatics.

Lymphoedema in the head or neck can also cause symptoms inside your mouth and throat. This may include swelling of your tongue and other parts of your mouth.

Tell your doctor or nurse straight away if you have:

any swelling or a feeling of fullness or pressure
find it difficult to swallow
have changes in your voice

They will refer you to a lymphoedema specialist if they think you might have lymphoedema. It’s important to start treatment early to stop the swelling from getting worse.

Chyle leak

Chyle is tissue fluid (lymph) that contains fat after it has been absorbed from the small bowel (intestine). It gets transported through the lymphatic channels to the bloodstream.

Sometimes one of these channels, called the thoracic duct, leaks after the operation. When this happens, lymph fluid or chyle can collect under the skin.

You may need to stay longer in hospital and go back to the operating theatre to repair the leak.

Blood clot

Sometimes the tubes of the drain that the surgeon puts in during surgery can become blocked. This can cause blood to collect under the skin and form a clot (haematoma). If this happens, you might need to go back to the operating theatre to have the clot removed and the drain replaced.

Other possible effects

You might have other effects due to damage to some of the nerves that supply the head and neck area.

They include:

numbness of the skin and the ear on the same side as the operation
loss of movement in the lower lip
loss of feeling or movement on one side of the tongue

Let your doctor or specialist nurse know about any side effects that you have so they can help you to cope with them.