Lymph Node Removal Radical Prostectomy

Seventeen of them. Why?

Hi Peter

I had one lymph node removed along with the left nerve bundle and a margin of tissue when the left side of my prostate was unexpectedly found to be in poor mushy condition during laproscopic surgery.

That was in December 2012. Following the surgery my scrotum and penis became very swollen and I was readmitted to hospital twice. The first time due to the scrotal and penis swelling and the second due to urine bypassing the catheter very badly despite a district nurse and then A&E back flushing the catheter. In January my left leg started to swell over my shin bone and I attended three day clinics due to a suspect DVT.

Ultrasound scans found no blood clot but blood tests indicated a high risk of DVT. The evening before the third DVT clinic my abdomen started to swell even more than since the surgery and the next day I was admitted to hospital. A CT scan showed fluid build up mainly where my prostate had been removed but that was said to be normal. However I remained in hospital for a week and given nightly DVT injections. I asked could it be lymph problems causing the swelling in my abdomen, leg and scrotum but that was denied and seemed to annoy the nurses and doctors.

After discharge the swelling of my leg, foot and ankle continued, slightly but increasingly obviously to me. My foot ankle and lower leg also became slightly red. A GP prescribed knee length support hose which transferred the discomfort up into my thigh. I repeatedly asked could it be lymph problems, edna or lymphodema which again seemed to annoy the GPs. So I contacted McMmillan Cancer support who referred me the Lymphodema charity. Both McMilan and the Lymphodema charity confirmed that NHS medical professionals had problems accepting secondary lymphodema following cancer surgery was a problem, making diagnosis problematic and treatment by suitably qualified medical professionals difficult to obtain.

I was advised to seek an urgent referral to a lymphodema qualified professional, as early treatment and advice can ensure lymphodema does not get out of control. With the help of McMillan Cancer support I was referred to an NHS lymphodema qualified PT who confirmed lymph problems, measured my legs and provided full length compression stockings. The qualified lymphodema PT based the McMillan Centre within of the hospital I had been admitted to in January also liaised with and provided my GP with the necessary information and details to ensure repeat prescriptions, support hose and moisturising cream and the need to treat the fungal infection of my large toe to avoid the risk of infection increasing the probability of full blown lymphodema.

But the Consultant Urologist is still not convinced that lymph problems can occur due to the removal of one Orbturator Lymph Node. However when I check the medical publications on the subject I find medical professionals out with the UK confirming lymph problems such as lymphoceles in the abdomen and indeed swelling in the genitalia and legs following removal of lymph nodes, following prostate removal and other types of cancer surgery.

So I thought it worth asking if anyone else has had similar problems following removal of lymph glands with their prostate gland. Like you I am still leaky during the day but improving after nearly 8 months. I also have a hernia hence my other question.

Hi Peter

My problems are relatively minor as hopefully the cancer has not spread but time will tell. It will be interesting to see if anyone else does comment. I have seen most of the medical literature 142, suggested I look at and more. I have also had contact with many females who have had lymph problems and lymnhoidema but so far no men. Perhaps the men are reluctant to talk about there experiences or those who do have more serious problems than slight swelling.

As I understand your details your RP was some 13 months ago. Is that correct?

abprops,

Welcome aboard HW PC, sorry you needed to join our club, but glad you did.

To answer your question, I had open surgery in 2008 and my surgeon did not remove any lymph nodes. I often wonder if that was a mistake in my case. My surgery was considered failed within 9 months, and then I went on to Salvage Radiation. It too quickly failed, and I still have the cancer. My PSA as of April was 60.x and rising. I can't help but wonder if the remaining cancer is in the lymph nodes somewhere that weren't removed. So far, even with a recent PET scan/full body, thankfully no mets have appeared yet, at least not big enough to be picked up with scans.

Hope you do well ahead,

David in SC

My surgeon removed my lymph nodes when prostate was removed (Da Vinci) on 6/26/13.

..Yes I did also 18 of them..

16 nodes here, unfortunately one was positive for cancer !!

Yep I had lymph node removed and I did have a case of lymphedema for a while.

Hope your clears up. Mine did.

Cajun Jeff

I had 11 nodes removed with no issues.

Although the reported incidence of lymphocele and lymphedema varies greatly, it seems you were remarkably unlucky to have this complication from the removal of a single node.

You mentioned you received DVT injections. I assume this was heparin. There is some evidence that heparin raises the risk of lymphocele after lymphnode dissection.

It also seems surprising that only one was removed. I kind of wonder what the point was at all if only one was removed...

As the others have noted, it is not uncommon at all for some lymph nodes to be removed during a prostatectomy. Even with what is considered to be a low risk case.

I was a Gleason 6 but the doctor still removed 5 lymph nodes (all negative, thankfully) while performing nerve sparing surgery.

I think the better surgeons probably want to remove at least a few just to be as sure as possible.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.