Introduction

The information in this guide will help you get ready for your groin dissection surgery. It has information about what will happen on the day of surgery and how to manage your care after surgery.

Your surgeon and Sunnybrook nursing staff will go over this guide with you.

We know this may be a stressful time for you and you will be given a lot of information about your medical condition. This guide will help you keep track of what you need to do for your groin dissection surgery.

Your medical records are accessible online through MyChart, a service available to Sunnybrook patients. In order to use MyChart you will need a password, which can be picked up at the Medical Records Desk on the second floor of the Odette Cancer Centre (Room T2-212). You can also get a password by completing the form on this webpage. The website address for MyChart is MyChart.ca.

• Lymph nodes act as filters in the body's immune system.
• Lymph nodes also help remove excess fluid (lymph fluid) from the body.
• After lymph fluid is filtered in the lymph nodes it is delivered to the blood stream.

• Cancer cells can sometimes come off the main cancer and get carried in the lymph fluid and settle in the lymph nodes.
• The spread of the cancer can be detected by a sentinel node biopsy.
• The spread of the cancer can also be detected when you have a physical examination and the doctor can feel a lump (enlarged lymph node) in the groin. You may be able to feel the lump, too.
• If you have an enlarged lymph node, your surgeon or a radiologist will take a sample – or biopsy - from the lymph node to see if there is cancer in it.
• This sample is sent to a lab for analysis.
• This type of biopsy sample is called a fine needle aspirate (FNA).

Your surgeon will arrange some imaging tests before the groin dissection surgery. The tests may involve a CT scan or a CT/PET scan.

• A superficial groin dissection is also called an inguinal lymph node dissection.
• In this operation, the lymph nodes as well as the fatty tissue around the lymph nodes are removed from your groin. No muscle is removed.
• The purpose of this operation is to stop the cancer from growing and spreading any further.
• About 8 to 15 lymph nodes are removed in the surgery.
• All of the lymph nodes are sent to the lab for analysis and therefore no results will be available on the day of surgery.
• This operation takes 2 to 3 hours and is done under a general anesthetic.
• Stitches or staples will be used to put the skin back together after the skin cancer is removed.
• Two drains will be inserted and the drains may stay in up to 4 to 6 weeks.
• Your surgeon will take out the stitches and drains at your after-surgery appointment.

• Sometimes your surgeon may also perform a deep groin dissection, which is also called an iliac dissection.
• In this part of the operation, the surgeon removes the lymph nodes along the iliac blood vessels that are at the back of your abdomen.
• To reach these lymph nodes, the surgeon makes a cut through your abdominal wall muscle.
• During this part of the operation, another 5 to 15 lymph nodes are removed.
• This procedure, in combination with the superficial groin dissection, takes 3 to 4 hours under a general anesthetic.
• All of the lymph nodes are sent to the lab for analysis and therefore no results are available on the day of surgery.
• Stitches or staples will be used to put the skin back together after the skin cancer is removed.
• The stitches and drains will be taken out by your surgeon at your after-surgery appointment.
• Deep groin dissection can occur independent of, or in combination with a superficial groin dissection.
• The purpose of this operation is to stop the cancer from growing and spreading any further.

The diagram below shows the location of the lymph nodes that will be removed in a superficial and deep groin dissection.

Short-term side effects may include:

• A small risk of bleeding, which may look like a bruise. This happens to about 5 percent of patients – or 5 out of every 100 patients.
• A risk of infection. This happen in 30 to 40 percent of cases – or 30 to 40 patients out of every 100 who have the operation. An infection is usually treated with antibiotic pills.
• Difficulty with wound healing (20 percent, or 20 out of every 100 patients). This is more likely to happen if you are a smoker or you are diabetic. This is usually treated with wound dressings.
• A fluid build-up under the cut or incision (10 percent or 10 out of every 100 patients). This is a called a seroma. It can happen if the drains are not working properly or if the drains are removed. It can be drained with a needle in clinic.
• If you are a smoker, it is important to stop or cut back on smoking.
• If you are diabietic, it is important to keep your blood sugar under control (blood glucose 5 to 7).

Long-term side effects:

• Swelling of the leg or lymphedema (60 to 70 percent of patients). This can be permanent. It can be managed with lymphatic massage, wearing compression stockings and exercise. You can be referred to the lymphedema clinic. 
• Swelling can happen in the upper part of the leg alone, or along the length of the leg – including the foot.
• Your thigh, and maybe your abdominal wall, will be numb after the surgery. The numbness may become less over time, but it will not return to the way if felt before the surgery.
• Difficulty with walking. Due to scarring or lymphedema, you may need to adjust your walking speed.