Retroperitoneal lymph node dissection (RPLND)

The lymph nodes are part of the lymphatic system, which helps to fight against infections. The body has many lymph nodes. With a retroperitoneal lymph node dissection (RPLND), the goal is to remove the lymph nodes in the back of the abdomen. These are called retroperitoneal lymph nodes.

RPLND may be used to treat testicular cancer. Doctors may perform a retroperitoneal lymph node dissection to:

• Remove lymph nodes that may have cancer
• Find out whether the cancer has spread 
• Lower the chance of cancer returning 

Four ways to prepare for a retroperitoneal lymph node dissection

Before this procedures, patients should be sure to:

• Alert their care team in advance about any medications they use, including over-the-counter herbs and supplements. Patients may be asked to stop taking certain medications in the days leading up to this procedure.
• Obtain guidance on how to prepare for general anesthesia. For example, they may be asked to not eat or drink anything after midnight on the day of surgery.
• Find out what follow-up appointments may be necessary after surgery.
• Ask for specific instructions on caring for and dressing the surgical wound at home

What to expect from a retroperitoneal lymph node dissection

A retroperitoneal lymph node dissection is a long and often challenging surgery. This is because the surgeon will likely try to avoid damaging nerves located in the back of the abdomen. If these nerves are damaged or removed, one possible side effect is retrograde ejaculation. When this happens, semen is pushed into the bladder rather than outside of the body. Because testicular cancer often occurs in men at the age when they plan to have children, the surgeon may use an approach called nerve-sparing surgery to keep the nerves intact.

Patients receive general anesthesia for the surgery in the hospital operating room. The surgeon may use an approach called open surgery, which involves a wide incision in the middle of the abdomen. Or, the surgeon may use a robotic or laparoscopic approach, which involve smaller incisions.

The retroperitoneal lymph nodes are removed from the same side as the tumor or from both sides of the abdomen. The surgeon then sends the lymph nodes and any other tissue removed to a pathologist who studies them for signs of cancer.

Once finished, the surgeon places a small tube and a drainage bag to collect fluid and drain it from the area. Draining this fluid may help improve healing. Patients should expect to have this drain for a couple of days or until the drainage stops.

After a retroperitoneal lymph node dissection, patients may need medications such as antibiotics and pain relievers.

Patients typically go home from the hospital three days to a week after the procedure.

Benefits and risks of a retroperitoneal lymph node dissection

The benefits of a retroperitoneal lymph node dissection include determining whether cancer is present to plan treatment or to lower the chance of cancer occurring or recurring in that area of the body.

As with any surgery, there are risks and side effects associated with a retroperitoneal lymph node dissection. They include:

• Inability to pass gas or have a bowel movement
• Bulge at the incision site or near it
• Fertility problems (retrograde ejaculation)
• Short-term infection or bowel blockage
• Pain or sensitivity in the lower abdomen

Patients who experience any of these side effects should inform their care team.

Having a retroperitoneal lymph node dissection shouldn’t affect a man’s ability to have an erection, orgasm or sex. However, a patient who undergoes chemotherapy followed by surgery may face a lack of ejaculation and other effects. Men should ask their care team in advance about these concerns, including any fertility-related questions and the possibility of banking sperm.

Reviewing the results of a retroperitoneal lymph node dissection

Once a pathologist examines the lymph nodes that were removed during the retroperitoneal lymph node dissection, the results will be sent to the doctor, who will share them with the patient. A negative lymph node doesn’t have any cancer, while a positive lymph node has cancer.

The pathologist typically writes a report with detailed information, such as the type of cancer and number of lymph nodes with cancer cells. This information is used to stage the cancer, based on how far it’s advanced. Knowing the stage of the cancer helps doctor and patient make treatment decisions. Patients shouldn’t hesitate to ask their doctor or another member of the care team to explain anything from the report that is unclear.

The results from a retroperitoneal lymph node dissection may also determine whether additional tests or treatments are needed.