Lymph Node Removal and infection Risk?

Larry, my wife has had two bouts with breast cancer each requiring surgery and standard removal of the some of the underarm nodes, generally the first route of spread. In 1996 she had 11 nodes removed, all clear. In 2010 she had the remaining nodes removed, again clear. Since then she has had chronic severe lymphadema throughout her right arm as the lymphatic channels have no nodes to drain into. Severe swelling and problems with movement follow. So for nearly 10 years she has worn a full arm compression sleeve 24/7/365. Plus she goes to physical therapy every two weeks for special deep arm massage to help dissipate the lymphatic fluid that pools in her arm.

She has not been told by any doctor that this in any way has negatively affected her immune system, but how would they really know? I have searched for studies regarding it and have found nothing specific. So it is very real and I am aware of men that have had the condition in their legs following node removal with RP. I have no idea how common it is, but it is permanent and their is no effective treatment or reversal. The nodes do not grow back.

Your info from the NCI is very good and illustrative of the situation my wife is in. Thankfully, you appear not to be negatively affected by the node removal. It is probably because there are many nodes in the pelvic area and surgeons will tell you there is no way to remove them all as many can’t even be found. Thus even though many were removed, you still have many that function. This is another reason that node sampling is controversial and not universal in the USA. With breast cancer the underarm nodes are well defined and easy for then surgeon to remove as they are in a cluster concentrated in a small area without much fat or any other organs.

From the following and others studies I've seen, the jury is still out. Personally, having had 16 nodes removed and found all negative gives me some peace of mind. Obviously, if any had been found positive, it would have prompted adjuvant therapy. As the letter below points out, there are dual purposes to an ePLND: removing positive nodes in an effort to affect outcomes and identifying LN spread to help determine treatment.

Effect of Extended Pelvic Lymph Node Dissection on Oncologic Outcomes in Patients with D'Amico Intermediate and High Risk Prostate Cancer Treated with Radical Prostatectomy: A Multi-Institutional Study (2019)

"...
In a multi-institutional database of 4 centers we identified 9,742 patients who underwent radical prostatectomy from 2000 to 2017 with or without pelvic lymph node dissection
...
CONCLUSIONS:
There was no significant difference in oncologic outcomes in patients with D'Amico high or intermediate risk prostate cancer in whom pelvic lymph node dissection was or was not performed at radical prostatectomy. The therapeutic value of pelvic lymph node dissection remains unclear."

Extended pelvic lymph‐node dissection is independently associated with improved overall survival in patients with prostate cancer at high‐risk of lymph‐node invasion (2020, Letter to ed.)

"...
Limitations notwithstanding, our present study is the first to preoperatively identify patients in whom an ePLND may confer a direct survival advantage, in addition to superior prognostication (indirect benefit). As we identify these patients preoperatively, this may facilitate patient counselling and optimal utilisation of ePLND"

The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy (2020)

"Conclusions
Over the long term after RARP for PCA, the risk of hospital readmission is associated with ePLND. In patients who underwent RARP and ePLND, 4.4% of them had a readmission, compared to RARP alone, in which only 0.8% of cases had a readmission. When ePLND is planned for staging pelvic lymph nodes, patients should be informed of the increased risk of hospital readmission."