Overview

Open retroperitoneal lymph node dissection (RPLND) is an operation to remove the lymph nodes at the back of your tummy (abdomen).

Lymph nodes are small bean-shaped structures that filter out harmful cells from your lymphatic fluid. This includes filtering out cancer cells.

When you have cancer, your lymph nodes might become swollen or feel hard.

Removing your retroperitoneal lymph nodes is a way to treat testicular cancer.

Benefits of RPLND

There are 3 reasons why we might recommend an RPLND for you.

Preventing cancer from coming back

In most cases, we recommend an RPLND after you’ve completed chemotherapy treatment.

Chemotherapy usually kills any active cancer cells. After chemotherapy, your lymph nodes might not shrink back to their normal size. This is because there might be some leftover cells (teratoma) in your lymph nodes.

These cells could become cancerous again in the future. An RPLND aims to stop this from happening by removing your lymph nodes.

Removing cancer cells

There’s a chance that the cells in your lymph nodes might already be cancerous. In this case, removing your lymph nodes also removes the cancer.

The only way to know if the cells are cancerous is by testing the lymph nodes after they’ve been removed.

Cancer staging

We sometimes recommend an RPLND before you’ve had any chemotherapy. This is usually after you’ve had a testicle removed with a radical orchidectomy. In this case, an RPLND is a staging procedure, which helps us understand if the cancer has spread.

We test the lymph nodes after we remove them. If the results show that there are no cancer cells, it’s very unlikely that the cancer will come back in the future.

If there are cancer cells, we might recommend chemotherapy treatment for you.

Risks of an RPLND

Like all operations, an RPLND has some risks.  We’ll discuss all the risks with you so you know what to expect. Talk to us if you’re worried about the risks or have questions.

General risks of surgery include:

• complications with having a general anaesthetic
• blood clots in a vein (deep vein thrombosis)
• blood clots in the lung (pulmonary embolism)
• infection
• stroke
• heart attack

Along with these general risks, there are some specific risks of having an RPLND.

Damage to blood vessels

This is the main risk of an RPLND. Your retroperitoneal lymph nodes are found near your major blood vessels. If your lymph nodes are stuck to your major blood vessels, we need to separate them carefully. This can lead to blood vessel damage.

About 1 in 100 patients have internal bleeding after an RPLND. If this happens, you might need a blood transfusion and another operation.

About 2 in 100 patients need to have some blood vessels removed and replaced with a tube. This is called a vascular graft.

Damage to your ureter or kidneys

Your lymph nodes might be attached to the tube that connects your kidneys to your bladder (ureter). If your surgeon thinks your ureter could get damaged during an RPLND, they’ll put a small mesh tube (stent) in the ureter to protect it.

In rare cases, your lymph nodes might be stuck to a nearby kidney. If they cannot be separated, we might need to remove the kidney together with your lymph nodes. This happens to 1 in 250 patients.

Fluid build-up

After an RPLND, lymphatic fluid can build up in the area where the lymph nodes were removed. If this leaks, it can cause swelling in your tummy, leg and testicle area. This is called a chyle leak.

We might recommend a special diet for you to reduce the chances of a chyle leak. You’ll usually follow this diet for 2 weeks.

Usually, the leak heals on its own. If it does not, you might need to have another procedure to drain it. In rare cases, you might need another operation.

Infertility

An RPLND can cause retrograde ejaculation, which is also known as dry orgasms. This means that when you orgasm, your semen goes into your bladder instead of coming out through your penis. Your orgasm will still feel the same as usual.

Your semen will leave your body with your urine when you pee. This is not physically harmful, but it’s likely that you and your partner will not be able to get pregnant (conceive).

Your surgeon will let you know if this is likely to happen to you.

If you’re planning to have a baby in the future, you might be able to freeze your sperm before having surgery. This will depend on how recently you had chemotherapy. Talk to your doctor or nurse if you’re interested in freezing your sperm.

Keyhole surgery

A standard RPLND is major surgery that involves making a large surgical cut.

If you’re concerned about having major surgery, we have special robotic equipment at our hospitals that we can use for keyhole surgery.

Keyhole surgery involves making several small cuts instead of one large cut. This can make it quicker to recover compared to standard surgery.

You might not be able to get keyhole surgery if you’ve had chemotherapy recently. Talk to your surgeon to find out what options are available for you.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to have the procedure or treatment, we’ll ask you to sign a consent form. This says that you understand what’s involved and agree to have the treatment.

Read more about our consent process.