Retroperitoneal Lymph Node Dissection (RPLND)
Surgery for Testicular Cancer
RPLND removes lymph nodes from the retroperitoneum, the area behind the abdominal cavity near major blood vessels. Testicular cancer often spreads first to these nodes, so surgery targets them to eliminate hidden cancer cells. It typically involves an open approach through a midline abdominal incision. This is major abdominal surgery requiring time in the operating room and weeks of recovery.
1. What is RPLND?
RPLND removes lymph nodes from the retroperitoneum, the area behind the abdominal cavity near major blood vessels. Testicular cancer often spreads first to these nodes, so surgery targets them to eliminate hidden cancer cells.
It typically involves an open approach through a midline abdominal incision. This is major abdominal surgery requiring time in the operating room and weeks of recovery.
2. Why is RPLND performed?
a) Primary RPLND
Primary RPLND is often used for early stage non seminomatous testicular cancer. It stages the disease by checking for spread and treats it by removing affected nodes. In some cases, it may be enough on its own, depending on individual factors.
b) Post chemotherapy RPLND
This surgery addresses masses that remain after chemotherapy. These may contain active tumor, non cancerous growths, or scar tissue. Removing them may cure the disease in certain patients and helps decide if more treatment is needed.
3. What happens before surgery?
Preparation includes imaging like CT scans to assess the area. Tumor markers such as AFP, hCG, and LDH are tested in blood. A physical exam reviews your health and fitness for surgery.
Your surgeon discusses fertility risks and sperm banking options. An anesthesia review covers your medical history and pain management. Medications are adjusted, and you receive instructions for hospital admission.
4. What happens during surgery?
The surgeon makes an incision in the middle of your abdomen to access the retroperitoneum. Major blood vessels like the aorta and vena cava are identified and protected. Lymph nodes are removed from specific areas based on cancer spread patterns.
A nerve sparing technique may be used to help preserve ejaculation function. The procedure lasts several hours, with close monitoring for blood loss.
5. What to expect after surgery
In hospital
You recover in a monitoring area, sometimes intensive care depending on the case. Pain is managed with medications, epidurals, or pumps. Bowel function returns gradually, starting with clear fluids. Hospital stay is typically several days.
At home
Full recovery takes weeks, with fatigue and soreness common. Avoid heavy lifting or strenuous activity for 4 to 6 weeks or as advised. Keep the incision clean and watch for issues. Returning to work or driving depends on your progress and job type.
6. Risks and possible complications
Common effects include pain, slow bowel movement, and tiredness. Surgical risks cover bleeding, infection, blood clots, or injury to bowel or vessels.
RPLND specific risks are ejaculatory changes like retrograde ejaculation, fertility issues, lymphatic fluid buildup, known as chylous ascites, and possible need for more treatment. Nerve sparing reduces some risks but outcomes vary.
7. Results and follow up
Pathology examines removed tissue for cancer type or scar. Results guide if further chemotherapy is needed. Tumor markers are checked regularly.
Surveillance involves exams, blood tests, and scans on a schedule that eases over time.
8. When to seek urgent help
Contact your doctor immediately for fever, severe abdominal pain, ongoing vomiting, leg swelling, or wound redness or discharge.
9. Disclaimer
This information provides a general overview of Retroperitoneal Lymph Node Dissection (RPLND). It is not a substitute for medical advice, diagnosis, or treatment. Your individual care plan may differ. Always follow the recommendations of a treating clinician.