Surgery to remove lymph nodes
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.
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When is an RPLND done?
If scans show that lymph nodes have not returned to normal size after chemotherapy, they may still contain cancer cells and your doctors may recommend you have an RPLND.
Some people have an RPLND instead of chemotherapy to treat enlarged lymph nodes found after an orchidectomy. This may happen because the type of non-seminoma cancer is not likely to respond to chemotherapy or radiation therapy, or to avoid some of the side effects of chemotherapy.
Chemotherapy or radiation therapy usually destroys seminoma cancer cells in the lymph nodes, so an RPLND is not often needed. If enlarged lymph nodes do remain after these treatments, you may be offered an RPLND. A small number of people may have an RPLND instead of chemotherapy or radiation therapy.
Having an RPLND
An RPLND is a long, complex operation that should be performed by an experienced surgeon in a specialist centre that does a high number of these procedures. There are 2 ways to perform an RPLND and your surgeon will discuss which approach is suitable for you.
- 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 lymph nodes and any remaining cancer (residual masses) from the back of the abdomen.
- In select cases, some highly trained surgeons may offer robotic (keyhole) surgery. The surgeon inserts surgical instruments through several small cuts in the abdomen with help from a robotic system.
For more on this, see How is surgery done?
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. Take it easy and pace yourself. 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 – An RPLND may damage the nerves controlling 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 usually causes infertility. If having children is important to you, talk to your surgeon about storing some sperm before an RPLND.
Podcast: Making Treatment Decisions
Dr Benjamin Thomas, Urological Surgeon, The Royal Melbourne Hospital and The University of Melbourne, VIC; A/Prof Ben Tran, Genitourinary Medical Oncologist, Peter MacCallum Cancer Centre, Walter and Eliza Hall Institute of Medical Research and The University of Melbourne, VIC; Dr Nari Ahmadi, Urologist and Urological Cancer Surgeon, Chris O’Brien Lifehouse, NSW; Helen Anderson, Genitourinary Cancer Nurse Navigator, Gold Coast University Hospital, QLD; Anita Cox, Youth Cancer – Cancer Nurse Coordinator, Gold Coast University Hospital, QLD; Dr Tom Ferguson, Medical Oncologist, Fiona Stanley Hospital, WA; Dr Leily Gholam Rezaei, Radiation Oncologist, Chris O’Brien Lifehouse and Royal Prince Alfred Hospital, NSW; Dheeraj Jain, Consumer; Amanda Maple, 13 11 20 Consultant, Cancer Council SA; Jessica Medd, Senior Clinical Psychologist, Department of Urology, Concord Repatriation General Hospital and Headway Health, NSW.
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