Surgery to remove lymph nodes
In some cases, an operation called a retroperitoneal lymph node dissection (RPLND or lymphadenectomy) is done to remove lymph nodes at the back of the abdomen that may contain cancer cells.
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Your doctors may recommend an RPLND if scans after chemotherapy show that the lymph nodes have not returned to normal size, as this may mean that they still contain cancer cells.
Chemotherapy or radiation therapy can usually destroy seminoma cancer cells in the lymph nodes, so an RPLND is rarely used. However, it may be offered for advanced seminoma cancer if there are no other treatment options.
The RPLND operation
An RPLND is a long, complex operation and should be performed by a surgeon with a lot of experience in the procedure. The standard approach involves open surgery, with a large cut made from the breastbone to below the bellybutton. The surgeon moves the organs out of the way, then removes the affected lymph nodes from the back of the abdomen (the retroperitoneum). Your surgeon can give you more information about this operation.
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 are used to. The main side effects are pain and tenderness in the abdomen. Tell your doctor or nurses if you are in pain, as they can prescribe medicines to make you more comfortable.
An RPLND may also damage the nerves that control ejaculation. This can cause retrograde ejaculation, which is when semen travels backwards into the bladder, rather than forwards out of the penis. Your surgeon may be able to use a technique called nerve-sparing surgery that avoids damaging these nerves, but this is not always possible.
Although retrograde ejaculation is not harmful, it causes infertility. If having children is important to you, you can store some sperm before an RPLND. Talk to your surgeon for more information.
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Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, North Metropolitan Health Service, WA; A/Prof Nicholas Brook, Senior Consultant Urological Surgeon, Royal Adelaide Hospital and The University of Adelaide, SA; Clinical A/Prof Peter Grimison, Medical Oncologist, Chris O’Brien Lifehouse and The University of Sydney, NSW; Dr Tanya Holt, Senior Radiation Oncologist, Radiation Oncology Princess Alexandra Hospital Raymond Terrace (ROPART), QLD; Brodie Kitson, Consumer; Elizabeth Medhurst, Genitourinary and Stereotactic Ablative Body Radiotherapy (SABR) Nurse Consultant, Peter MacCallum Cancer Centre, VIC; Rosemary Watson, 13 11 20 Consultant, Cancer Council Victoria.
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