Was a nodal (lymph node) dissection performed?

Nodal Dissection Assessment

Based on the evidence provided, if nodal resection was performed, the pathology report should indicate the level of nodal involvement and size of metastasis. 1

Determining if Nodal Dissection Was Performed

To determine if a nodal dissection was performed, you should:

• Review the operative note which should fully describe the anatomic boundaries of any lymph node dissection performed 1
• Check the pathology report for specific mention of lymph nodes and their evaluation 1
• Look for documentation of the number of lymph nodes examined, which is a measure of the completeness of a regional lymph node dissection 1
• Verify if the report mentions the level of nodal involvement and size of metastasis, which would indicate nodal assessment was done 1

Types of Nodal Assessments

Different approaches to nodal assessment may have been used:

• Complete lymphadenectomy (full standard lymphadenectomy): Dissection and assessment of both pelvic and para-aortic nodes 1
• Selective lymphadenectomy: A more tailored approach that may include sentinel lymph node (SLN) algorithm 1
• Sentinel lymph node biopsy (SLNB): Identification and removal of the first lymph node(s) to which cancer is likely to spread 1
• Lymph node "plucking" or "berry picking": Removal only of clinically involved nodes rather than a complete nodal group (not recommended) 2

Documentation Indicators

The following documentation would confirm nodal dissection was performed:

• Specific mention of "lymphadenectomy," "nodal dissection," or "sentinel lymph node biopsy" in operative notes 1
• Pathology report detailing the number of lymph nodes examined 1
• Description of the extent of dissection (e.g., pelvic nodes only, both pelvic and para-aortic nodes) 1
• Classification of the dissection as therapeutic (clinically positive nodes) or prophylactic/elective (clinically negative nodes) 2

Clinical Relevance

Understanding whether nodal dissection was performed is important because:

• It affects accurate staging of the cancer 1
• It guides appropriate adjuvant treatment decisions that can improve survival and decrease locoregional recurrence 1
• It identifies patients with nodal metastases who may require additional therapy 1
• The completeness of nodal dissection can impact long-term outcomes 3, 4

Common Pitfalls

• Assuming nodal assessment was done without explicit documentation 1
• Confusing "evaluation" of nodes with formal dissection 2
• Not recognizing that different surgical approaches (e.g., SLNB vs. complete lymphadenectomy) represent different extents of nodal assessment 1
• Failing to note that some operative reports may use varying terminology to describe nodal procedures 2