Surgery for testicular cancer

 

If the cancer is completely contained in the testicle (stage 1)| this operation may be the only treatment you’ll need.

After chemotherapy| some men may need further surgery if a CT scan| shows that the lymph nodes at the back of the tummy (retroperitoneal nodes)| are enlarged. These nodes may contain cells that could become cancerous in the future. Surgery to remove them is the only certain way of finding this out. After the operation the nodes are examined under a microscope.

Rarely these lymph nodes are removed in men with early teratoma who prefer to avoid surveillance| or adjuvant chemotherapy, as a way of finding out if the cancer has spread.

Retroperitoneal lymph node dissection (RPLND) Back to top

The operation to remove the nodes is called a retroperitoneal lymph node dissection. It’s a major operation which is carried out by experienced surgeons in specialist centres. Your surgeon and specialist nurse will explain what is involved and the possible complications and side effects of this operation.

Before the operation you will usually be seen at a clinic to have blood tests and tests to check that your heart and lungs are healthy. You’ll be given information and advice about preparing for the operation.

You may be asked to cut down on fibre (eg fruit, vegetables and pulses) in your diet for a few days before your operation. When you’re admitted to hospital you’ll be given laxatives to empty your bowel. This is because the bowel, which is near the lymph nodes, will be handled during 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 moves your bowel and other organs aside.

After your operation

When you get back to the ward you’ll have a drip of fluid and salts going into your vein until you’re able to eat and drink normally. You’ll 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 getting a chest infection or a blood clot. You’ll also have support stockings to wear that help 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 painkilling drugs regularly to control any pain. If you still have pain, let your nurse or doctor nurse know so 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. Your staples are usually removed 7–10 days after the operation. It may be up to 10 days before you’re ready to go home. If necessary a district nurse can change your wound dressings at home.

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 to begin with, but will eventually fade.

Possible complications Back to top

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. However, after your operation you’ll be monitored very closely and may be looked after in a high dependency/intensive care unit for the first few days. Your doctors and nurses will do regular checks to look for signs of complications. This means that if any occur they can be treated straight away.

Effect on fertility

Another possible complication of this operation is infertility (inability to father children), which is due to nerve damage during the operation. You’ll still be able to ejaculate but your semen will go into your bladder and passes 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 to have an orgasm.

Before the operation, your doctor should advise you about sperm banking| (storing samples of sperm).

Keyhole surgery (laparoscopic retroperitoneal dissection) Back to top

This operation is still quite new. The surgeon makes several cuts in the tummy area and inserts a long thin tube with a tiny light and camera on the end (called a laparoscope), which has surgical instruments attached to it. They look through the laparoscope and use the instruments to remove the lymph nodes through the cuts. People usually recover more quickly from keyhole surgery because it doesn’t involve having a big open operation.

In 2006 the National Institute for Health and Clinical Excellence (NICE) reviewed laparoscopic retroperitoneal dissection. NICE advises the government on the best treatments to use in the NHS. It found that with this operation men could go home after about four days and had fewer problems with dry climax and bleeding. However, NICE also identified some potential problems with this operation. These include injury to a blood vessel, damage to the bowel, bleeding, incomplete removal of the cancer, and a risk that the cancer could come back. Your doctor should explain the risks and uncertainties before you make a decision.

This is very complicated surgery and it should only be done by experienced surgeons.

Surgery to other parts of the body Back to top

After chemotherapy, if there are still signs of cancer in areas such as the lungs|, brain| or liver|, some men may have surgery. These operations are only done by experienced surgeons in specialist units. If you need this type of operation your doctor will talk it over with you so that you understand what’s involved.