Retroperitoneal lymph node dissection (RPLND)

Having an RPLND is a major operation. It is only done by experienced surgeons in specialist centres. Your surgeon and specialist nurse will explain what is involved, and the possible complications and side effects.

You have the operation 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 your surgeon has to move your bowel and other organs aside to reach them.

Sometimes, surgeons can do this operation using keyhole surgery. For example, this may be an option if you have not previously had chemotherapy. This means you will have several small cuts (incisions) rather than one longer one. This is sometimes called laparoscopic or robotic retroperitoneal lymph node dissection. Keyhole surgery is very specialised, and only experienced surgeons should do it. There are only a few hospitals that can offer this type of surgery.

As keyhole surgery involves several small cuts, it can be quicker to recover from than standard surgery, where you have one longer cut.

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 have:

• fluids directly into a vein by an infusion (drip) until you can eat and drink normally
• a tube draining your bladder (catheter), attached to a bag to collect urine
• a tube draining from your wound, attached to a bottle to collect excess fluid and help the wound to heal.

You will only need these tubes for a short time. They will usually be taken out before you go home.

Your treatment team will encourage you to start moving about as soon as possible. This helps to reduce complications like chest infections or blood clots. You will also need to wear support stockings (TED stockings). These help prevent blood clots in your legs. A physiotherapist or specialist nurse may give you some gentle leg and breathing exercises to do.

If you have pain, let your nurse or doctor know. You will have painkillers regularly to control any pain. But if you still have pain, you can have a different painkiller or a higher dose.

All operations have possible complications and these will depend on the type of operation you have. Your surgeon will discuss these with you before your operation.

The most common complications after surgery are:

• a wound infection
• bleeding in the operation area
• a chest infection
• developing a blood clot.

The nurses will monitor you for these complications. Let them know straight away if you have:

• any bleeding, or feel unwell
• symptoms of an infection, such as a cough or feeling short of breath
• discharge from your wound
• swelling and redness in a limb.

With RPLND surgery, 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 develop, they can treat them straight away.

Sometimes during RPLND 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. But this is very rare.

A common side effect of this operation is dry ejaculation. You will still be able to ejaculate, but your semen will go into your bladder instead. This is known as retrograde ejaculation or dry climax. The semen will then leave your body when you next pass urine (pee).

If you cannot ejaculate in the usual way, you will not be able to get someone pregnant without fertility treatment. But you should still be able to get an erection and have 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.

Your doctor will advise you to store sperm before the operation, if this is appropriate for you.

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 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.

For more support, visit our testicular cancer forum to talk with people who have been affected by testicular cancer, share your experience, and ask an expert your questions.