If testicular cancer does spread, it most commonly spreads to the lymph nodes at the back of the abdomen (the retroperitoneum). In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove these lymph nodes.
Having an RPLND
An RPLND is a long and complex operation, which should be performed by an experienced surgeon in a specialist centre. Sometimes, an RPLND is done instead of chemotherapy.
There are 2 ways to perform an RPLND:
- open surgery – a surgeon makes a large cut from the breastbone to below the bellybutton. The surgeon then removes the lymph nodes and any remaining cancer from the back of the abdomen.
- robotic surgery – this is a keyhole surgery where a surgeon inserts surgical instruments through several small cuts in the abdomen with help from a robotic system.
Side effects of RPLND
It can take many weeks to recover from an RPLND. At first, you will probably be very tired and may not be able to do as much as you’re used to.
Other side effects include:
| Pain | It is common to have pain and tenderness in the abdomen. Your doctor can prescribe pain medicines to make you more comfortable. |
| Ejaculation | RPLND can sometimes damage the nerves that help with ejaculation. This means semen might not come out of the penis during orgasm (called anejaculation or “dry orgasm”). It’s not harmful, but it can affect fertility. Some surgeons can use a special method called nerve-sparing surgery to try to protect these nerves, but it’s not always possible. If you may want to have children in the future, talk to your surgeon about storing sperm before the surgery. |
| Fluid build-up in abdomen (belly) | Called chylous ascites, lymphatic fluid can build up in the abdomen after an RPLND. You may feel bloated or your belly could feel swollen. Sometimes, the fluid will need to be drained. Your doctor will advise you. |
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A/Prof Peter Grimison, Medical Oncologist, Chris O’Brien Lifehouse and Royal Prince Alfred Hospital, NSW; Marc Diocera, Genitourinary Nurse Consultant, Peter MacCallum Cancer Centre, VIC; A/Prof Peter Heathcote, Urologist, Brisbane Urology Clinic, QLD; Dr Michael Huo, Radiation Oncologist, Princess Alexandra Hospital, QLD; A/Prof Joseph McKendrick, Medical Oncologist, Epworth Eastern Hospital, VIC; Dr Tonia Mezzini, Sexual Health Physician, East Obstetrics and Gynaecology, SA; Dominic Oen, Clinical Psychologist, Bankstown Cancer Centre, NSW; Dr Benjamin Thomas, Urological Surgeon, The Royal Melbourne Hospital and The University of Melbourne, VIC; Paul Zawa, Consumer.
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