Inguinal lymph node dissection
Inguinal lymph node dissection removes the lymph nodes in the groin, where penile cancer usually spreads first. It is done to find out whether the cancer has spread and, if it has, to remove it.
Also called ILND, Groin lymph node dissection, Groin dissection, Inguinal lymphadenectomy, Removal of groin lymph nodes, Modified inguinal lymphadenectomy, Radical inguinal lymphadenectomy, Dynamic sentinel node biopsy
- Where
- Hospital operating room
- Anesthesia
- General anesthesia
- Time in the room
- About 1 to 2 hours per groin for a full dissection; about 1 hour for a sentinel node biopsy
- Hospital stay
- Usually 1 to 3 nights after a full dissection; often the same day after a sentinel node biopsy
- Going home with
- A drain in each operated groin, usually for 1 to 3 weeks
- Back to normal
- About 4 to 6 weeks after a full dissection; about 1 to 2 weeks after a sentinel node biopsy
- Back to work
- 2 to 4 weeks for desk work; 6 weeks or more for physical work
Overview
Lymph nodes are small, bean-shaped glands that filter a clear fluid called lymph. Lymph from the penis drains to the nodes in both groins first, and from there to nodes deeper in the pelvis. Penile cancer spreads in this orderly way, which means that cancer found only in the groin nodes can often still be cured by removing them.
Groin nodes that feel normal can still hide small amounts of cancer. In men whose penile tumor is deeper or more aggressive, roughly 1 in 4 has hidden cancer in normal-feeling groin nodes. Waiting until the nodes become enlarged lowers the chance of cure. That is why guidelines recommend checking the groin nodes with surgery in these men.
There are several ways to do this. For normal-feeling groins, experienced centers often start with a dynamic sentinel node biopsy: a tracer finds the first node or two that drain the tumor, and only those are removed through a small cut. If they contain cancer, the rest of the nodes on that side are removed. Other centers do a modified dissection, which removes a smaller set of nodes. When nodes are enlarged and contain cancer, a radical dissection removes all the nodes in a wider area. Some centers do the dissection through small keyhole cuts on the thigh (video endoscopic or robotic dissection).
If several groin nodes contain cancer, or cancer has broken through the wall of a node, your team may also recommend removing the pelvic lymph nodes, and chemotherapy before or after surgery. The main challenges after a full groin dissection are wound healing and leg swelling, which this page explains so you can watch for them.
The parts of your body involved
The groin lymph nodes sit in a triangle of fat at the top of each thigh, just below the crease where the leg meets the belly. This area is called the femoral triangle. Its upper edge is the inguinal ligament, a firm band running from the hip bone to the pubic bone. The superficial nodes lie in the fat just under the skin. The deep nodes lie next to the large femoral artery and vein, which carry blood to and from the leg. A large surface vein, the great saphenous vein, runs up the inner thigh to join the femoral vein here. Lymph from the leg also passes through this area, which is why removing these nodes can cause leg swelling.
- Superficial groin lymph nodes
Nodes in the fat just under the skin of the groin. They are usually the first to receive lymph from the penis.
- Deep groin lymph nodes
Nodes alongside the femoral vein, under a deeper layer of tissue.
- Femoral artery and vein
The main blood vessels to and from the leg. They are protected throughout surgery.
- Great saphenous vein
A surface vein of the leg. Surgeons try to keep it during a modified dissection to reduce leg swelling.
- Inguinal ligament
A firm band in the groin crease that marks the upper edge of the dissection.
- Pelvic lymph nodes
Nodes deeper inside the pelvis, next in line after the groin nodes.
Why it’s done
Removing the groin nodes has two jobs: to find out whether penile cancer has spread, and to remove cancer that has. Both have a direct effect on your chance of cure.
- Finding hidden spread
Scans can miss small amounts of cancer in normal-sized nodes. Looking at the nodes under a microscope is the most accurate way to know.
- Cure
When penile cancer has spread only to a few groin nodes, removing them can cure it in many men.
- Planning further treatment
The number of nodes with cancer, and whether cancer has broken out of a node, decide whether pelvic node surgery, chemotherapy or radiation is needed.
- Preventing problems in the groin
Cancer left to grow in groin nodes can break through the skin, bleed and become infected. Removing it prevents this.
- Peace of mind with fewer side effects
For normal-feeling groins, a sentinel node biopsy can show whether the nodes are clear with a much smaller operation.
Other options
- Surveillance (watching)
For very shallow, low-risk penile cancers, regular groin exams and sometimes ultrasound are enough, because the chance of spread is low. If a node appears, it is checked right away.
- Dynamic sentinel node biopsy
For normal-feeling groins, removing only the first one or two nodes that drain the tumor. A full dissection is done only if they contain cancer. Best done in centers with experience.
- Needle biopsy of an enlarged node
A thin needle guided by ultrasound takes cells from an enlarged node. It can confirm cancer before surgery, but a negative result does not always rule it out.
- Chemotherapy before surgery
For large, fixed or many groin nodes, chemotherapy is often given first to shrink the cancer and make surgery safer and more effective.
- Radiation
Radiation, sometimes with chemotherapy, may be used after surgery when the risk of return is high, or instead of surgery when surgery is not possible.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before (sentinel node biopsy)
The morning of
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Finding the sentinel nodes
If a sentinel node biopsy is planned, a tracer injected near the penile tumor travels through the lymph channels to the first nodes in each groin. In the operating room, a blue dye may also be injected, and a hand-held probe that detects the tracer guides the surgeon to these nodes.
More detail
The tracer is usually a technetium-99m colloid, and the probe is called a gamma probe. Using both tracer and dye makes it more likely the right nodes are found.
The surgeon sits at a console a few steps from you and moves every instrument with hand controls and foot pedals. The robot cannot move on its own or make decisions.
A camera on one arm gives the surgeon a bright, three-dimensional picture magnified about ten times, which helps them see small nerves and vessels.
The instruments are about the width of a pencil and bend like a wrist inside your body, so the surgeon can stitch and dissect through small openings.
A bedside assistant and a scrub nurse stay at the table, and the anesthesia team watches your breathing and blood pressure throughout. Most U.S. hospitals use the da Vinci system made by Intuitive.
After the operation
Right afterward
- Getting up
Most teams want you up and walking the day after surgery. Some ask you to limit bending at the hips for the first day or two. Practice varies.
- Blood clot prevention
You receive blood thinner injections and wear squeezing sleeves on your legs. Some teams continue the injections at home for up to about 4 weeks.
- Drains
Nurses measure the fluid from each drain and teach you how to empty and record it.
- Leg position
Keeping your legs raised when you are in bed helps limit swelling.
- Catheter and pain
The urinary catheter usually comes out on the first day. Pain is controlled with regular medicines.
- Going home
Most men go home after 1 to 3 days with their drains in place.
At home
- Drains
Empty and record the amount from each drain once or twice a day. Drains usually come out when they collect less than about 30 to 50 milliliters (2 to 3 tablespoons) a day, often after 1 to 3 weeks.
- Wound care
Check the incisions every day for redness, opening or drainage. Keep them clean and dry as instructed.
- Showering
Showering is usually allowed after 48 hours. Secure the drains so they do not pull. Avoid baths and pools until the wounds are healed and the drains are out.
- Leg swelling
Some leg and genital swelling is common. Wear your compression stockings if prescribed, and raise your legs when sitting or lying down.
- Blood thinner injections
If you were sent home with them, take them every day for as long as instructed.
- Activity
Walk several times a day. Avoid sitting for long periods with your hips bent. Avoid lifting more than about 10 pounds, deep squats and strenuous exercise for about 4 to 6 weeks.
- Skin care
Protect the skin of your legs from cuts, insect bites and sunburn, and keep it moisturized. Infections in the legs are more likely after this surgery.
- Driving
Drive once you are off strong pain medicine, the drains are out, and you can brake without pain, often after 2 to 3 weeks.
- Sex
There is no set rule. Most men wait until the drains are out and they feel comfortable.
- Work
Desk work after 2 to 4 weeks. Physical work after 6 weeks or more.
Recovery timeline
- Day 0Surgery
You wake with dressings and a drain in each operated groin.
- Days 1 to 3Up and walking
Catheter out, walking, learning drain care. Most men go home.
- Week 1At home with drains
Short walks, legs up when resting, daily wound checks.
- Weeks 1 to 3Drains out
Drains come out once the fluid slows down. A fluid pocket may form later and can be drained in the clinic if needed.
- About 2 weeksPathology review
Your team explains how many nodes were removed, whether any contained cancer, and what comes next.
- Weeks 4 to 6Healing
Most wounds are healed. Activity gradually returns to normal.
- 3 monthsSwelling check
Your team checks for lasting leg swelling and refers you to a lymphedema therapist if needed. The first cancer follow-up exam or scan.
- Years 1 to 5Follow-up
Regular exams, and scans when needed, every few months at first, then less often.
What it feels like
Hearing that your lymph nodes need to be removed can feel like bad news, even when the purpose is to make sure the cancer has not spread. The recovery is slower than many men expect, mostly because of drains and wound healing, and patience helps.
Hearing the plan
Many men fear that node surgery means the cancer has spread everywhere.
What helpsOften the surgery is done to check normal-feeling nodes. Even when nodes contain cancer, removing them can cure many men. Ask your surgeon to explain your situation.
Waking up
Tightness and soreness in both groins, with tubes coming out of the skin.
What helpsRegular pain medicine and a pillow under the knees help. The drains look alarming but are not usually painful.
The first walk
A pulling feeling in the groins and fear that the wound will open.
What helpsWalk slowly and upright with support. Walking is safe and helps prevent clots.
Living with drains
Drains are awkward, catch on clothing, and are a constant reminder of the surgery.
What helpsA lanyard or a pouch on your clothing holds the bulbs. Loose pants help. Drains are temporary.
A numb inner thigh
A patch of numb or tingling skin on the front and inner thigh is common and can feel strange.
What helpsSmall skin nerves are cut during surgery. The numb area often shrinks over months, though some numbness may stay.
Heavy legs
Legs or the scrotum can feel heavy and swollen, especially at the end of the day.
What helpsCompression stockings, raising your legs and walking help. A lymphedema therapist can teach massage and wrapping.
If the wound has a problem
A wound that opens or leaks can be frustrating and discouraging.
What helpsWound problems are common after this surgery and usually heal with dressings and time. Your team or a wound nurse will guide you.
How well it works
The main result is the pathology report: how many nodes were removed and whether any contained cancer. This tells you and your team the stage of the cancer and what, if anything, comes next.
- If the nodes are clear
The outlook is very good. You continue with regular follow-up exams.
- If nodes contain cancer
Your team looks at how many nodes are involved and whether cancer broke through a node's wall. This guides whether you need pelvic node surgery, chemotherapy or radiation.
- Sentinel node results
A clear sentinel node means the other nodes on that side are very likely clear too. The test can rarely miss cancer, so groin checks continue during follow-up.
- Follow-up
Exams of the groins and penis, and scans when needed, every 3 to 6 months for the first 2 years, then less often for at least 5 years.
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
After an open full dissection, wound infection, skin edge breakdown or the wound opening is common. Most are minor and heal with dressings and antibiotics. They are much less common after a sentinel node biopsy.
Fluid can collect under the skin after the drain is removed (a seroma or lymphocele). It often settles but may need draining in the clinic.
Some swelling of the legs or scrotum is common in the first weeks.
Small skin nerves are cut, leaving a numb patch. It often improves but may be permanent.
Less common
Lasting swelling of the legs or genitals affects a minority of men. The risk is higher after a radical dissection, pelvic node removal or radiation. It can be managed with stockings, massage and therapy.
Part of the skin flap can lose its blood supply and need wound care or a further operation.
Clots in the leg veins or lungs. Blood thinner injections, compression and walking lower the risk.
Blood can collect under the skin and occasionally needs a return to the operating room.
Some men need to come back to hospital for wound care or infection.
Rare
Damage to the main leg artery, vein or nerve is rare.
A deep infection needing surgery or prolonged antibiotics is rare.
Rarely, the sentinel node is clear but cancer is present in other nodes. This is why follow-up checks continue.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- Spreading redness, warmth, pus or a bad smell from an incision
- The wound opens, or the skin edge turns dark or black
- A sudden large, tense swelling in the groin, or the drain output suddenly becomes bright red or much heavier
- A drain falls out or stops draining and the groin swells
- One leg becomes red, hot and painful, or swells much more than the other
- Calf pain, chest pain or sudden shortness of breath (call 911)
Questions to ask your surgeon
- Do I need my groin nodes removed, or could I be watched?
- Would a sentinel node biopsy be suitable for me?
- Will you operate on one side or both?
- Will this be a modified or a radical dissection, and why?
- Do you offer the keyhole or robotic approach, and is it right for me?
- How many of these operations does your team do each year?
- Will you keep the saphenous vein?
- How long will the drains stay in, and who will take them out?
- Will I need blood thinner injections at home?
- What is my risk of leg swelling, and should I see a lymphedema therapist?
- If the nodes contain cancer, will I need pelvic node surgery, chemotherapy or radiation?
Words you may hear
- Lymph node
- A small gland that filters lymph and can trap cancer cells.
- Lymph
- A clear fluid that travels through lymph channels back toward the bloodstream.
- Inguinal
- Relating to the groin.
- Sentinel lymph node
- The first lymph node that receives lymph from a tumor.
- Dynamic sentinel node biopsy
- Using a tracer, a scan and a probe to find and remove the sentinel nodes.
- Modified dissection
- Removing a smaller set of groin nodes, often keeping the saphenous vein, to lower side effects.
- Radical dissection
- Removing all the superficial and deep nodes from a wider area of the groin.
- Femoral triangle
- The area at the top of the thigh where the groin nodes and the main leg vessels lie.
- Great saphenous vein
- A large surface vein that runs up the inner leg to the groin.
- Seroma or lymphocele
- A pocket of lymph fluid under the skin after surgery.
- Lymphedema
- Swelling caused by lymph fluid that cannot drain normally.
- Extranodal extension
- Cancer that has broken through the outer wall of a lymph node.
- Closed suction drain
- A thin tube and soft bulb that draw fluid out from under the skin.
- VEIL
- Video endoscopic inguinal lymphadenectomy: removing groin nodes through small cuts with a camera.
Common questions
Why remove nodes that feel normal?
Normal-feeling nodes can still contain small amounts of cancer. For deeper or more aggressive penile cancers, finding and removing it early gives a better chance of cure than waiting until the nodes grow.
Is a sentinel node biopsy as good as a full dissection?
In experienced centers, it finds most cancer spread with far fewer side effects. It can occasionally miss cancer, which is why your groins are still checked during follow-up.
Will this affect my erections or sex life?
The nerves and vessels for erections do not run through the groin, so the operation itself does not usually affect erections. Swelling of the scrotum or penis can make sex uncomfortable for a time.
Will my legs still work normally?
Yes. Walking and leg strength are not affected. The main long-term issue for some men is swelling, which can be managed.
How long will I have drains?
Usually 1 to 3 weeks. They come out once the amount of fluid drops below a level your surgeon sets.
Can lymphedema be prevented?
Not always, but the risk is lower with smaller dissections, keeping the saphenous vein, early walking, compression and good skin care. If swelling develops, early treatment with a lymphedema therapist helps.
Will I need chemotherapy?
Only if several nodes contain cancer or the cancer has broken out of a node. Your team will explain this once the pathology report is back.
Sources this page draws on
- European Association of Urology and American Society of Clinical Oncology, EAU-ASCO Collaborative Guidelines on Penile Cancer
- American Cancer Society, Penile Cancer: Surgery for Penile Cancer
- Urology Care Foundation, Penile Cancer
- MedlinePlus (U.S. National Library of Medicine), Lymphedema
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.