Retroperitoneal Lymph Node Dissection

What is a retroperitoneal lymph node dissection (RPLND)?

Retroperitoneal lymph node dissection (RPLND) is a surgical procedure that removes lymph nodes from the abdomen. It's a type of lymphadenectomy. Lymph nodes are small structures that help filter the body and fight disease. They are a part of the immune system. Lymph nodes are located throughout the body. This procedure removes lymph nodes located in the retroperitoneal section of the body—a space behind the organs in the abdomen.

This procedure can also be used in the staging process for cancer. The stage of the cancer tells you how severe it is and how far it has spread throughout the body. Once the lymph nodes are removed during a RPLND, they are sent to a lab to provide staging information.

Why are lymph nodes removed during a retroperitoneal lymph node dissection (RPLND)?

Lymph nodes are removed during a RPLND to prevent the spread of cancer. This procedure can be used as a treatment for testicular cancer. Testicular cancer is cancer that develops in one of the testicles—glands that hang below the penis. The testicles are responsible for producing hormones (testosterone) and sperm. When you have testicular cancer, the cancer typically starts in one testicle. Less severe cases of testicular cancer can be treated with chemotherapy and less invasive treatments. However, in more serious cases, the cancer can spread through the lymph nodes in the retroperitoneal (area in the back of the abdomen) space into other parts of the body. Surgically removing the lymph nodes can stop the spread of the cancer.

How is a retroperitoneal lymph node dissection (RPLND) done?

Retroperitoneal lymph node dissection (RPLND) is a long surgery done with the patient under general anesthesia. During the procedure, your surgeon will make a cut into the abdomen to remove lymph nodes on the same side as the affected testicle. If the left testicle is affected, the lymph nodes on the left side of the abdomen will be removed.

The main goal of this procedure is to remove all cancer so that it does not spread. Your surgeon may need to remove more than just the lymph nodes on one side of your body to accomplish this goal. Other structures the surgeon may need to remove can include:

• Lymph nodes on the other side of the body: If the cancer has spread to both sides of the body, the lymph nodes on the other side of the retroperitoneal space will also be removed.
• Blood supply: The blood supply to the affected testicle and sperm cord may need to be removed.

What happens after a retroperitoneal lymph node dissection (RPLND)?

Right after RPLND, your doctor will place a drain in your abdomen to get rid of any extra fluid. The fluid will be collected in a bag outside of the body and will be left in place for a few days. Because RPLND is a surgery that takes several hours, you can expect to stay in the hospital for a few days after the procedure.

What are the risks of retroperitoneal lymph node dissection (RPLND)?

There are several risks involved in retroperitoneal lymph node dissection (RPLND). These risks can include:

• Damage to the blood vessels: Because the surgeon will be working with and close to several large blood vessels, there is a risk of bleeding.
• Retrograde ejaculation: This is a condition where the fluid that is typically ejaculated (semen) moves backward into the bladder instead of exiting the body. Men with this condition can still have sex. However, because semen no longer exits the body, men with retrograde ejaculation cannot father children. In vitro fertilization can be used to achieve pregnancy in these cases.
• Lymphocele: Fluid can collect in the space where the lymph nodes are removed. A drain, placed in the abdomen, will help to rid your body of this excess fluid.
• Post-surgery complications: Risks like infection, respiratory problems, damage to other internal structures, pus at the incision site, pain in the lower abdomen and constipation can all also occur after surgery.

What is the benefit of retroperitoneal lymph node dissection (RPLND)?

Retroperitoneal lymph node dissection (RPLND) is used to both diagnose (staging) and treat cancer. This procedure can prevent the spread of cancer to other parts of the body by removing the lymph nodes.

What is the outlook after a retroperitoneal lymph node dissection (RPLND)?

Retroperitoneal lymph node dissection (RPLND) is used to both stage cancer and prevent it from spreading by removing the lymph nodes. In cases where the surgeon is able to remove all cancer, the outlook is positive. After reviewing the lab results of lymph nodes removed from your body, your doctor may use additional therapies (chemotherapy) after surgery to continue to treat testicular cancer. Testicular cancer has a very high survival rate.