Retroperitoneal Lymph Node Dissection
Understanding How Testicular Cancer Spreads
The lymphatic system is a network of vessels that carry lymph - a colorless fluid that contains infection-fighting white blood cells – throughout the body. As the lymph travels through the vessels it passes through small structures called lymph nodes, which act as filters. If any foreign or harmful substances are found, the immune cells in the lymph node attack and attempt to destroy them.
After a cancer diagnosis, doctors will often biopsy the lymph nodes closest to the tumor to determine if any cancer cells have broken loose and are traveling through the lymphatic system. With testicular tumors, the cancer cells will almost always spread to the lymph nodes near the aorta (the body’s main artery) and inferior vena cava (the body’s main vein) that are located in the abdominal cavity posterior to the intestines. Because the abdominal cavity is surrounded by a membrane called the peritoneum, the lymph nodes contained within it are called retroperitoneal lymph nodes.
Retroperitoneal Lymph Node Dissection (RPLND) As a Treatment Option
RPLND is surgery to remove the lymph nodes in the abdomen that are likely to contain cancer cells that have traveled (metastasized) from the primary tumor in the testicle(s). It may be the primary form of treatment for testicular cancer or a secondary form of treatment after chemotherapy. RPLND can also help to establish the exact stage and type of cancer. The procedure may be done in addition to orchiectomy (surgical removal of one or both testicles) depending on the type and stage of the tumor.
- What Happens During RPLND Surgery?
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RPLND is a major surgery done in the operating room under general anesthesia. The surgeon makes an incision in the abdomen that extends from a few inches under the breastbone to several inches below the belly button. Through this incision, the urologic oncologist will remove the lymph nodes in the retroperitoneum. The locations where the lymph nodes are removed will be determined based on patient- and disease-specific factors.
RPLND surgery is both delicate and complex and can take up to 4-6 hours in the operating room. Patients can expect to stay in the hospital for 3-4 days while they recover and their incision begins to heal. Full recovery can take 4-6 weeks and your doctor will advise you when you can resume normal activities.
- Will I Still Need Chemotherapy after RPLND?
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When chemotherapy is the first choice of treatment and is successful, RPLND surgery may not be necessary. However, if there is residual disease in the retroperitoneum after chemotherapy, RPLND is normally advised depending on cancer type. Post-chemotherapy RPLND is much more challenging as chemotherapy can cause the lymph nodes to fuse to the delicate structures in the abdominal cavity, making them more difficult to remove.
When RPLND is the first course of treatment, some men are able to avoid chemotherapy altogether. Only you and your doctor can decide on the best course of treatment for you.
- What Are The Potential Complications of RPLND Surgery?
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RPLND is a proven treatment for testicular cancer, but it is a serious surgery with the potential for complications. The most frequent complications are wound infections. Although the experts at UH use the most advanced nerve-sparing techniques, some men may experience problems with ejaculation after the surgery, including:
- Anejaculation: The inability to ejaculate
- Retrograde ejaculation: Semen backs up into your bladder instead of exiting through your penis. This affects fertility. Those men who are concerned about their fertility may be advised to bank their sperm before the surgery.
If template dissections and nerve-sparing techniques are possible, preservation of ejaculatory function is nearly 100 percent. The ability to get an erection will not be affected by the surgery.
Advanced Expertise Required for Successful RPLND
Because testicular cancer is relatively rare, there are very few experts in the region trained and experienced in this proven, yet technically challenging procedure. At University Hospitals, we are pleased to offer patients the expert care of urologic oncologist, Adam Calaway, MD, who has the experience and advanced training to offer RPLND surgery as a treatment option to his patients with testicular cancer.