Retroperitoneal lymph node dissection
The operation to remove the lymph nodes at the back of the tummy is called a retroperitoneal lymph node dissection.
This is a major operation that is carried out by experienced surgeons in specialist centres. Your surgeon and specialist nurse will explain what’s involved, and the possible complications and side effects of this operation.
Before the operation, you’ll usually have blood tests and other tests to check that your heart and lungs are healthy. You’ll be given information and advice about preparing for the operation.
The operation is done under a general anaesthetic.
Your surgeon will make a long cut from the top of your tummy (near your breastbone) to below your belly button. To remove the lymph nodes, your surgeon has to move your bowel and other organs aside.
You’ll be monitored very closely after your operation and may be looked after in a high dependency/intensive care unit for the first few days.
You’ll be given fluids into a vein by an infusion (drip) until you’re able to eat and drink normally. You may have drainage tubes from your wound to stop any excess fluid collecting, and to help the wound heal. The tubes will only be needed for a short time and will be taken out before you go home.
After your operation, you’ll be encouraged to start moving about as soon as possible. This helps to reduce complications like chest infections or blood clots. You’ll also
need to wear support stockings, which help to prevent blood clots in your legs. A physiotherapist or specialist nurse may give you some gentle leg and breathing exercises to do.
You’ll be given painkillers regularly to control any pain. If you still have pain, let your nurse or doctor know. They can increase the dose of your painkiller or change it.
How long you need to be in hospital depends on how quickly you recover and whether you have any complications. It may take up to 10 days before you’re ready to go home. If necessary, a district nurse can change your wound dressings at home. Most surgeons use dissolvable sutures, which don’t need to be removed.
It may take a few months before you feel fully recovered from your operation. You’ll be left with a long vertical wound, which will be red and swollen at first but will gradually fade.
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All operations have possible complications and your surgeon will discuss these with you beforehand. The most common complications are bleeding and infection in the wound.
The bowel may also take a while to start working normally again. Your doctors and nurses will do regular checks to look for signs of complications, so that if any occur they can be treated straight away.
Occasionally during surgery, the lymph nodes are found to have become attached to a nearby structure, such as the kidney. If the lymph nodes cannot be separated from the kidney, the kidney may also need to be removed.
Effect on fertility
Another common side effect of this operation is infertility, which is due to nerves being divided during the operation. You’ll still be able to ejaculate, but your semen will go into your bladder and pass out harmlessly the next time you pass urine. This is known as retrograde ejaculation or dry climax. However, this is becoming less of a problem as surgeons use new ‘nerve-sparing’ techniques to help protect the nerves.
This operation won’t usually have any physical effect on your ability to get an erection or have an orgasm. Your doctor will advise you to store sperm before the operation.
For men who’ve not had previous chemotherapy, it may be possible to have keyhole surgery to remove the retroperitoneal lymph nodes (laparoscopic retroperitoneal dissection). This depends on a number of factors including the stage of the cancer. Keyhole surgery is very specialised and should only be done by experienced surgeons.
During the operation, the surgeon makes several cuts in the tummy and inserts a long, thin tube with a tiny light and camera on the end (called a laparoscope). This has surgical instruments attached to it. They look through the laparoscope and use the instruments to remove the lymph nodes through the cuts.
Recovery from keyhole surgery is quicker because it doesn’t involve having a big, open operation. It’s usually possible to go home about four days after keyhole surgery.
Although recovery is usually faster, there may be some possible complications. These include injury to a blood vessel, damage to the bowel, bleeding and the possibility of incomplete removal of the cancer.
The National Institute for Health and Clinical Excellence (NICE) advises the government on the best treatments to use in the NHS in England and Wales. It recommends that keyhole surgery should only be carried out:
if a person has been fully informed of the potential risks and uncertainties of this type of surgery beforehand
if the outcome of the surgery is carefully monitored by the hospital team afterwards
by a surgeon experienced in laparoscopic surgery.