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Retroperitoneal Lymph Node Dissection (RPLND)

Depending on the type and stage of the cancer, some lymph nodes at the back of the abdomen (around the large blood vessels known as the aorta and inferior vena cava) may also be removed at the same time as the orchidectomy or during a second operation. Not all patients with testicular cancer need to have lymph nodes removed, so it’s important to discuss this (and the possible alternatives) with A/Prof Patel.

RPLND is a complex and long operation. A large incision is typically made down the middle of the abdomen to remove the lymph nodes. It should be performed by a surgeon who has significant experience in the procedure as it is very complex.

Side effects

Most side effects from this surgery tend to be temporary. Typically pain and discomfort around the operation site are the most common side effects, but this pain can be managed with painkillers, and should subside over time.

Surgery to remove retroperitoneal lymph nodes is a major operation. Serious complications are not common, but they can happen. About 5% to 10% of patients have temporary complications after surgery, such as bowel obstruction or wound infections. The standard approach for an RPLND requires a large incision in the abdomen, which will leave a scar and can take some time to heal. Mobility will be limited for some time after the operation. This is less likely with laparoscopic surgery, which uses smaller incisions.

This type of surgery does not cause impotence – a man can still have erections and sexual intercourse. But it might damage some of the nerves that control ejaculation. If these nerves are damaged, when a man ejaculates, the semen is not propelled forward through the urethra to exit the body but rather goes backwards into the bladder. This is known as retrograde ejaculation, and it can make it hard to father children.

To save the normal ejaculation function, surgeons have developed a type of retroperitoneal lymph node surgery called nerve-sparing surgery that is very successful when done by experienced doctors. Testicular cancer often affects men at an age when they may be trying to have children. These men may wish to discuss nerve-sparing surgery with their doctors, as well as sperm banking (freezing and storing sperm cells obtained before treatment).