Retroperitoneal lymph node dissection (RPLND)

Some men have surgery to remove the retroperitoneal lymph nodes at the back of the tummy. This is a major operation carried out by experienced surgeons. It leaves a scar from above your tummy to below your belly button.

Your surgeon will explain what’s involved and the possible complications. The operation may affect your fertility so your surgeon may advise you to store sperm first. You will still be able to get an erection after surgery. But when you ejaculate your semen goes into your bladder and passes out with your urine.

For the first few days you may be cared for in a high dependency unit. You’ll have fluids as a drip (infusion) and tubes coming from your wound. These are removed after a few days. The nurses will make sure your pain is controlled. You may be in hospital for up to 10 days. It may take a few months to recover when you go home.

Some men are offered keyhole surgery, when several small cuts are made instead of one long one. This is only done in a few hospitals.

Retroperitoneal lymph node dissection (RPLND)

This is an operation to remove the lymph nodes at the back of the tummy (abdomen). This may be occasionally used for testicular cancer. It’s 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.

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. As these lymph nodes are behind the spine, your surgeon has to move your bowel and other organs aside to reach them.

Before your operation

If you smoke, try to give up or cut down before your operation. This will help reduce your risk of chest problems, such as a chest infection, and will help your wound heal after the operation. Your GP can also give you advice.

You’ll meet a member of the surgical team and a specialist nurse to discuss the operation. This may be at a pre-assessment clinic before you’re admitted for your operation. Make sure you ask any questions or talk over any concerns you have about the operation. If you think you may need help when you go home after your surgery, for example because you live alone or are a carer for someone else, bring this up as soon as possible. This will help the staff make arrangements in plenty of time.

You may have tests before the operation, such as:

  • a chest x-ray
  • blood tests
  • a urine test
  • an ECG (a recording of your heart).

You’ll usually be admitted to hospital on the morning of the operation. You’ll meet a member of the surgical team and nursing team. You’ll also meet the doctor who’ll give you your anaesthetic (the anaesthetist). They’ll be able to answer any questions you have about the anaesthetic and pain control after the operation.

You may be given elastic stockings (TED stockings) to wear during and after the operation, to prevent blood clots in your legs.

After your operation

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.

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 stitches, which don’t need to be removed. You’ll have a long vertical wound, which will be red and swollen at first. This will heal but will leave a long scar that will gradually fade.

It may take a few months to fully recover from your operation. Your doctor will advise you about when you can lift heavy objects such as bags of shopping, drive and return to work.

Possible complications

All operations have possible complications and your surgeon will discuss these with you beforehand. The most common complications are bleeding and a wound infection. 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. This 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 does not usually have any physical effect on your ability to get an erection or to have an orgasm. Your doctor will advise you to store sperm before the operation.

Keyhole surgery (laparoscopic retroperitoneal dissection)

Men who have not had previous chemotherapy may be offered keyhole surgery to remove the retroperitoneal lymph nodes. This involves having several small cuts rather than one longer one. Keyhole surgery is very specialised and should only be done by experienced surgeons. There are only a few hospitals that can offer this type of surgery.

Back to Surgery explained

Surgery for testicular cancer

Surgery to remove the testicle is needed to diagnose cancer. It’s also the main treatment when the cancer hasn’t spread.

What happens after surgery?

You’ll be monitored very closely after your operation. You will be very tired so it’s important to rest and look after yourself.