For decades, lymph node removal has been an accepted and often unquestioned component of cancer surgery. The rationale is clear: remove potential pathways of spread, gain a clearer picture of disease progression, and reduce recurrence risk. But as cancer treatment increasingly pivots towards immunotherapy, new research is forcing us to reconsider whether this long-standing approach always serves patients’ best interests.
Recent studies from the Peter Doherty Institute for Infection and Immunity, published in Nature Immunology, suggest that lymph nodes may be far more than passive channels for metastasis. Instead, they appear to be central command centres for anti-tumour immunity – critical to the generation and maintenance of stem-like T cells that underpin durable immune responses.
These stem-like T cells are not simply another immune subset. They are the engine room of long-term cancer control, capable of self-renewal and of producing the effector cells required to attack tumours. The Doherty Institute’s work shows that lymph nodes provide a uniquely supportive environment for these cells; one that other immune organs, including the spleen, cannot replicate.
The implications are uncomfortable but necessary to confront. If lymph nodes are essential for sustaining effective immune responses, then their routine removal may inadvertently compromise the very treatments that now define modern oncology, including checkpoint inhibitors and CAR-T therapies. In striving to eliminate cancer locally, are we sometimes dismantling the immune infrastructure needed to control it systemically?
This research may also shed light on one of immunotherapy’s greatest puzzles: why some patients experience profound, long-lasting benefit, while others see little response. The answer may lie not only in tumour genetics, but in the health, function and preservation of lymph nodes themselves.
Importantly, this is not an argument to abandon lymph node surgery. Rather, it is a call for careful consideration. As cancer care becomes more personalised, surgical decision-making must evolve alongside advances in immunology. Preserving immune competence may, in some cases, be as critical as removing malignant tissue.
While these findings are currently based on preclinical models, clinicians are already exploring their relevance in patient samples. This is translational science at its best – challenging assumptions, refining practice and reminding us that progress often begins by asking uncomfortable questions.
As immunotherapy continues to reshape cancer outcomes, the message from this research is clear: to defeat cancer, we may need to protect the body’s own best weapons – not remove them.
Link to paper: Lymph nodes found to be key to successful cancer immunotherapy | Doherty Website
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