# Lymphadenectomy (lymph node dissection)

Source: https://onco.cc/terms/lymphadenectomy/  
OnCo record `lymphadenectomy` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Surgically removing the lymph nodes that drain a tumour, both to stage the cancer and to clear any spread.

## Summary

The extent is organ-specific: D2 gastrectomy removes perigastric and regional nodes; axillary dissection clears levels I-II for breast cancer; neck dissection is graded by levels for head and neck cancer; retroperitoneal dissection is used in testicular cancer. It improves staging accuracy (and so adjuvant decisions) and sometimes cure, at the cost of lymphoedema, nerve injury and longer surgery. Sentinel node biopsy has replaced it wherever a negative sentinel node is reliable.

## Fields

- Kind: Term
- Last checked: 2026-09-09
- Also known as: lymph node dissection; nodal dissection; axillary dissection; axillary lymph node dissection; neck dissection; D2 lymphadenectomy; D2 dissection; pelvic lymph node dissection; retroperitoneal lymph node dissection; mediastinal node dissection; lymph node sampling

## Notes

- Breast cancer, the axilla: NICE NG101 (1.4.11) says to offer axillary node clearance to people whose preoperative ultrasound-guided needle biopsy proved lymph node metastases, (1.4.12) to offer further axillary treatment (clearance or radiotherapy) after a sentinel node biopsy showing 1 or more macrometastasis, (1.4.13) to discuss the benefits and risks of no further treatment with women who have 1 or 2 macrometastases after breast-conserving surgery and have been advised to have whole-breast radiotherapy with systemic therapy, (1.4.14) not to offer further treatment for micrometastases alone, and (1.4.15) to classify isolated tumour cells as lymph node-negative.
- Radiotherapy instead of clearance: in the 10-year analysis of AMAROS, 1,425 patients with a positive sentinel node were randomised to axillary lymph node dissection (744) or axillary radiotherapy (681); the 10-year cumulative axillary recurrence was 0.93 percent after dissection and 1.82 percent after radiotherapy, with no difference in overall or disease-free survival, and lymphoedema at 5 years was 24.5 percent after dissection against 11.9 percent after radiotherapy.
- Leaving the axilla alone after a positive sentinel node: in ACOSOG Z0011, 891 women with T1 or T2 cancer, no palpable adenopathy and 1 or 2 positive sentinel nodes, all having lumpectomy with tangential whole-breast radiotherapy, had a 10-year overall survival of 86.3 percent with sentinel node dissection alone against 83.6 percent with axillary dissection (non-inferior). In SENOMAC, 2,540 patients in the per-protocol analysis with 1 or 2 sentinel-node macrometastases, about 90 percent of whom had nodal radiotherapy, had a 5-year recurrence-free survival of 89.7 percent without completion dissection against 88.7 percent with it.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Lymphadenectomy
- Wikipedia: https://en.wikipedia.org/wiki/Lymphadenectomy
- NICE NG101: early and locally advanced breast cancer, recommendations (updated 2025): https://www.nice.org.uk/guidance/ng101/chapter/Recommendations
- Bartels et al., radiotherapy or surgery of the axilla after a positive sentinel node, 10-year results of AMAROS (JCO 2023): https://doi.org/10.1200/JCO.22.01565
- Giuliano et al., axillary dissection versus no axillary dissection, 10-year results of ACOSOG Z0011 (JAMA 2017): https://doi.org/10.1001/jama.2017.11470
- de Boniface et al., omitting axillary dissection in breast cancer with sentinel-node metastases, SENOMAC (NEJM 2024): https://doi.org/10.1056/NEJMoa2313487
- DiSipio et al., incidence of unilateral arm lymphoedema after breast cancer: systematic review and meta-analysis (Lancet Oncology 2013): https://doi.org/10.1016/S1470-2045(13)70076-7

## Connected records

- terms: [Cording (axillary web syndrome)](https://onco.cc/terms/cording-axillary-web-syndrome/), [Doing less to the armpit](https://onco.cc/terms/axillary-surgery-de-escalation/), [Gastrectomy](https://onco.cc/terms/gastrectomy/), [Lymph node status (node-positive / node-negative)](https://onco.cc/terms/lymph-node-status/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/breast-cancer-related-lymphoedema/), [Lymphoedema after breast cancer treatment](https://onco.cc/terms/lymphoedema-after-breast-cancer/), [Numbness and nerve pain after breast surgery](https://onco.cc/terms/numbness-after-breast-surgery/), [Radical (extended) cholecystectomy](https://onco.cc/terms/radical-cholecystectomy/), [Retroperitoneum](https://onco.cc/terms/retroperitoneum/), [Sentinel node biopsy](https://onco.cc/terms/sentinel-lymph-node-biopsy/), [Targeted axillary dissection](https://onco.cc/terms/targeted-axillary-dissection/)
- cancers: [Ampullary cancer (ampulla of Vater)](https://onco.cc/cancers/ampullary/), [Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell)](https://onco.cc/cancers/appendiceal-adenocarcinoma/), [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/), [Cancer of unknown primary, favourable subsets](https://onco.cc/cancers/cup-favourable-subsets/), [Cystic duct carcinoma](https://onco.cc/cancers/cystic-duct-carcinoma/), [Early gastric cancer](https://onco.cc/cancers/early-gastric-cancer/), [Extrahepatic cholangiocarcinoma (perihilar and distal)](https://onco.cc/cancers/extrahepatic-cholangiocarcinoma/), [Gallbladder cancer](https://onco.cc/cancers/gallbladder/), [Goblet cell adenocarcinoma of the appendix](https://onco.cc/cancers/goblet-cell-adenocarcinoma/), [HPV-associated vulvar squamous cell carcinoma](https://onco.cc/cancers/hpv-associated-vulvar-cancer/), [HPV-independent vulvar squamous cell carcinoma (p53-mutant)](https://onco.cc/cancers/hpv-independent-vulvar-cancer/), [Incidental gallbladder cancer (found after cholecystectomy)](https://onco.cc/cancers/incidental-gallbladder-cancer/), [Intrahepatic cholangiocarcinoma](https://onco.cc/cancers/intrahepatic-cholangiocarcinoma/), [Localised adrenocortical carcinoma (ENSAT stage I to III, resectable)](https://onco.cc/cancers/localised-adrenocortical-carcinoma/), [Localised penile cancer (organ-confined, node-negative)](https://onco.cc/cancers/localised-penile-cancer/), [Localised small bowel adenocarcinoma (stage I to III, resected)](https://onco.cc/cancers/localised-small-bowel-adenocarcinoma/), [Node-positive and metastatic penile cancer](https://onco.cc/cancers/node-positive-penile-cancer/), [Penile cancer](https://onco.cc/cancers/penile/), [Placental-site trophoblastic tumour and epithelioid trophoblastic tumour](https://onco.cc/cancers/placental-site-trophoblastic-tumour/), [Recurrent and metastatic nasopharyngeal carcinoma](https://onco.cc/cancers/recurrent-metastatic-nasopharyngeal-carcinoma/), [Resectable pancreatic ductal adenocarcinoma](https://onco.cc/cancers/resectable-pdac/), [Small intestine cancer (small bowel adenocarcinoma)](https://onco.cc/cancers/small-bowel/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/), [Vaginal adenocarcinoma (including DES-associated clear cell adenocarcinoma)](https://onco.cc/cancers/vaginal-adenocarcinoma/), [Vaginal squamous cell carcinoma (HPV-associated)](https://onco.cc/cancers/vaginal-squamous-cell-carcinoma/)
- fronts: [Surgery & Interventional](https://onco.cc/fronts/surgery/)
- trials: [ACOSOG Z0011 (Alliance)](https://onco.cc/trials/acosog-z0011/), [ALMANAC (Axillary Lymphatic Mapping Against Nodal Axillary Clearance)](https://onco.cc/trials/almanac/), [AMAROS (EORTC 10981-22023)](https://onco.cc/trials/amaros/), [EORTC 10801](https://onco.cc/trials/eortc-10801/), [IBCSG 23-01](https://onco.cc/trials/ibcsg-23-01/), [NSABP B-04](https://onco.cc/trials/nsabp-b04/), [NSABP B-32](https://onco.cc/trials/nsabp-b32/), [OPT-IN (EA2197)](https://onco.cc/trials/opt-in/), [SENOMAC](https://onco.cc/trials/senomac/)
- technologies: [Surgery for gallbladder cancer: simple versus radical cholecystectomy, re-resection and lymphadenectomy](https://onco.cc/technologies/gallbladder-cancer-surgery/)
- key papers: [Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection](https://onco.cc/key-papers/paper-pawlik-incidental-gallbladder-cancer-residual-disease-jgs-2007/)
- ideas: [A trial of sparing the liver resection in peritoneal-side (T2a) gallbladder cancer](https://onco.cc/ideas/idea-gbc-t2a-spare-liver-resection-trial/)
- people: [Mitsuru Sasako](https://onco.cc/people/mitsuru-sasako/)

---
JSON: https://onco.cc/api/v1/entities/lymphadenectomy.json