Surgery for non-Hodgkin lymphoma

Surgery isn’t a common treatment for non-Hodgkin lymphoma (NHL). This is because other treatments such as chemotherapy, targeted drugs or radiotherapy usually work well.

You might have surgery to remove a lymph node to test for lymphoma. This is a lymph node biopsy Open a glossary item

Some people with NHL might have surgery to remove their spleen Open a glossary item. This surgery is called a splenectomy. You might have this surgery for a type of NHL called splenic marginal zone lymphoma.

Removing a lymph node

Your doctor removes part or all of a swollen lymph node. They do this under local anaesthetic Open a glossary item or general anaesthetic. Open a glossary item  They send it to the laboratory.

pathologist Open a glossary item looks at it under a microscope to see if it contains lymphoma cells. They can also find out what type of NHL you have. They look at proteins on the surface of the cells and use special chemical stains.

Removing the whole lymph node is called an excision biopsy. It is a very small operation. You will have a few stitches and possibly some bruising and stiffness. 

Doctors sometimes use an ultrasound scan Open a glossary item or a CT scan Open a glossary item. This helps to guide the needle into the lymph node to take a sample of tissue. You usually have this under local anaesthetic.

Removing your spleen (splenectomy)

The spleen is an organ on the upper left side of your tummy (abdomen).

It is part of the lymphatic system and filters the blood, removing worn out red blood cells. It also stores red blood cells and contains lymph node tissue and many lymphocytes. Lymphocytes are types of white blood cells. Your white blood cells help fight infection.

When do you have surgery to remove your spleen?

You might have this surgery if you have a very rare type of lymphoma called splenic marginal zone lymphoma.

Rarely, you might have a splenectomy for other types of lymphoma. You might have this surgery if your spleen is swollen. But this is not very common.

You might also have a splenectomy to diagnose a lymphoma if it looks like it is only in your spleen.

Before your operation

You will have tests before your surgery to check you are fit enough to have the operation. You also have an appointment at the hospital pre assessment clinic. You will meet your surgeon and other members of the team looking after you. 

You will probably go into hospital on the day of your operation. Your doctor will tell you how long you might stay in hospital. 

Having your operation

Your surgeon might remove your spleen through either:

  • a large cut just under your ribs in the middle or left side of your abdomen Open a glossary item - this is called open surgery
  • a few small cuts in your abdomen - this is also called laparoscopic or keyhole surgery

During keyhole surgery, the surgeon put a thin tube called a laparoscope through one of the cuts. The tube has a camera attached. The surgeon can see the pictures of the inside of your abdomen on a TV screen. 

Through the other cuts they put in surgical instruments to remove your spleen.

You usually recover more quickly from keyhole surgery than open surgery. This means you can go home sooner. But it may not be possible for you to have keyhole surgery if your spleen is too large.

After your operation

It’s normal to have pain for the first week or so. You have painkillers to help control the pain. Your doctors and nurses give you painkillers by drip, tablets or liquids if you need them. 

You usually have drainage tubes that collect the fluid draining from the wound. Your nurse takes out the drainage tubes when there is no more fluid draining. This is normally after a couple of days.

Your nurse takes your drip out as soon as you can start eating and drinking again. This may take a couple of days. Your doctor listens to your stomach (abdomen) with a stethoscope. As soon as the doctor can hear your bowel working again, you start taking sips of water. Gradually you work up to eating and drinking normally.

You normally go home after about a week. You should be able to go home sooner if you have had laparoscopic surgery.  Everyone recovers at their own pace and your doctors make sure you are ready before you go home.

Helping protect you from infection

The spleen is part of your immune system and helps to fight infection. Without a spleen you will be more at risk of infection.

To help prevent infection in the future, you will need to have some vaccinations. You have these before, or just after, the operation. It is best to have these 2 weeks before surgery.

You will need to take antibiotics for the rest of your life because of these changes to your immune system.

In case of a medical emergency, you should carry a card saying you have had surgery to remove your spleen. Before you go abroad, talk to your doctor. They might advise extra vaccinations because your immunity is reduced.

  • Guideline for the diagnosis and management of marginal zone lymphomas: A British Society of Haematology Guideline
    R Walewska and others
    British Journal of Haematology 2024.  Volume 204, Issue1, Pages 86-107

  • Surgical management of splenic marginal zone lymphoma
    N Kennedy and others 
    Irish Journal of Medical Science, 2018. Volume 187, Issue 2, Pages 343-347

  • Still a role for surgery as first-line therapy of splenic marginal zone lymphoma? Results of a prospective observational study
    G Pata and others
    International Journal of Surgery, 2017 Volume 41, Pages 143-149

  • Treatment of splenic marginal zone lymphoma
    C Kalpadakis and others 
    Best practice and research clinical haematology, 2017. Volume 30, Issues 1-2, Pages139-148

  • Cancer: Principles and Practice of Oncology (12th edition)
    VT DeVita, TS Lawrence, SA Rosenberg
    Wolters Kluwer, 2023

Last reviewed: 
21 May 2024
Next review due: 
21 May 2027

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