Retroperitoneal lymph node dissection (RPLND)
Occasionally men with testicular cancer need a retroperitoneal lymph node dissection (RPLND).
This is an operation to remove the retroperitoneal lymph nodes at the back of your tummy (abdomen).
When testicular cancer has spread to the retroperitoneal lymph nodes, some men may need further surgery after having chemotherapy. Sometimes, a CT scan may show the lymph nodes are enlarged (longer than 1cm). They may have shrunk after chemotherapy, but are still bigger than they should be. This may mean the lymph nodes have cells inside that could become cancer in the future. Surgery to remove them is the only way of knowing for sure.
Rarely, these lymph nodes are removed in men with early-stage non-seminoma who cannot have surveillance or adjuvant chemotherapy. This shows if the cancer has spread or not and removes any nodes that might be affected.
A RPNLD is a major operation that is only done by experienced surgeons in specialist centres. The surgeon and nurse will explain what is involved, and the possible complications and side effects.
The operation is done under a general anaesthetic. The surgeon makes a long cut from the top of your tummy (near your breastbone) to below your belly button.
The lymph nodes are in front of the spine. This means the surgeon has to move your bowel and other organs aside to reach them.
Keyhole surgery for RPLND
Men who have not previously had chemotherapy may have the option of keyhole surgery to remove the retroperitoneal lymph nodes. This is sometimes called laparoscopic or robotic retroperitoneal lymph node dissection.
This type of surgery can be quicker to recover from. It means you have several small cuts rather than one longer one. Keyhole surgery is very specialised, and only experienced surgeons should do it. There are only a few hospitals that offer this type of surgery.
If you smoke, try to give up or smoke less before your operation. This will help reduce your risk of chest problems, such as a chest infection and helps your wound to heal after surgery.
You will meet a member of the surgical team and a specialist nurse to discuss the operation. This may be at a pre-assessment clinic. It is important to tell the anaesthetist if you have had bleomycin chemotherapy as a treatment.
We have more information about what to expect before surgery.
You may be looked after in a high-dependency or intensive care unit for the first few days. You will be monitored very closely after your operation. You will usually have:
- a drip (infusion) into your vein to give you fluids, until you can eat and drink normally.
- a tube into your bladder (a catheter) attached to a bag, to drain urine
- a drainage tube into your wound, to collect excess fluid and help the wound heal.
You will only need the tubes for a short time. They will usually be taken out before you go home. Your team will encourage you to start moving about as soon as possible. This helps to reduce complications like chest infections or blood clots.
You can read more about what to expect after surgery here.
Possible complications of RPLND
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. This means that if any occur, they can treat them straight away.
Sometimes during surgery the lymph nodes are found attached to a nearby structure, such as a kidney. If the surgeon cannot separate the lymph nodes from the kidney, they may need to remove both.
It may take up to 10 days before you are ready to go home. If necessary, a district nurse can change your wound dressings at home. Most surgeons use dissolvable stitches, which they do not need to remove. You will 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 when you can lift heavy objects (such as bags of shopping), drive and return to work.
Effects on fertility
Another common side effect of this operation is dry ejaculation. You will still be able to ejaculate, but your semen will go into your bladder. The semen will then leave your body harmlessly when you next pass urine (pee). This is known as retrograde ejaculation or dry climax. It means you cannot make someone pregnant in the usual way. But your doctor will advise you to store sperm before the operation. You and a partner may be able to use the stored sperm to have a child in the future.
The operation should not physically affect you getting an erection or having an orgasm.
This side effect is due to nerves being damaged during the operation. It is more likely if you have previously had radiotherapy to the lymph nodes at the back of the tummy. This can cause some scarring of the nerves. Sometimes, surgeons can adapt the surgery to use nerve-sparing techniques that try to protect the nerves.