17803 Retroperitoneal Lymph Node Dissection

Overview

Retroperitoneal lymph node dissection (say: RET-roh-per-ih-toh-NEE-al limf node dy-SEK-shun), or RPLND for short, is an operation to remove lymph nodes from the back of the abdomen. The 'retroperitoneum' is the space deep inside the belly, behind the organs and in front of the spine, wrapped around the large blood vessels. Lymph nodes are small bean-shaped glands that are part of the immune system — they filter body fluid and can trap cancer cells. 'Dissection' here just means careful surgical removal. RPLND is used most often for testicular cancer that may have spread to these nodes. It can be the first treatment for early-stage cancer, or it can be done after chemotherapy to remove any leftover tissue.

RPLND is not a common operation. Testicular cancer itself is uncommon, and only some people who have it need this surgery. Because it is specialised, it is usually done in a major cancer centre by a surgeon who performs many of these operations each year.

It is most often done for young men, usually between their late teens and early 40s, who have testicular cancer. It is occasionally done for older adults with other types of tumours in the same part of the body, and rarely for children with certain childhood tumours, who are cared for in specialist children's centres.

Symptoms

Common symptoms

• A lump or swelling in a testicle, which is often painless — this is the most common first sign.
• A heavy, aching or dragging feeling in the scrotum or lower belly.
• A dull ache in the lower back or groin.
• Enlarged lymph nodes seen on a CT scan, even when you have no symptoms at all.
• Sometimes no symptoms at all — the cancer may be found during tests done for another reason.
• After surgery, it is normal to have pain and soreness around the wound, tiredness, and swelling or numbness in the belly area for a while.

Symptoms in children

• RPLND is rare in children and is only considered for certain childhood tumours.
• Signs might include a painless swelling or lump in the belly, or changes caused by hormones the tumour makes.
• Children having this kind of surgery are cared for in specialist children's cancer centres, with extra support for the child and family.

Symptoms in older adults

• This surgery is much less common in older adults.
• When it is needed, it is more often for other types of cancer or rare lymph node conditions.
• Recovery can take longer, and other health conditions such as heart or kidney problems are carefully checked before surgery.
• Your care team will plan the operation around your general health and your own goals.

Causes

Main causes

• Testicular germ cell cancer that may have spread to the lymph nodes in the back of the abdomen.
• A leftover mass after chemotherapy for testicular cancer, which needs to be removed and checked.
• Less often, other tumours that start in or spread to the retroperitoneum, or rare conditions affecting the lymph nodes there.

Risk factors

• Being a young man with testicular cancer, most often between the ages of 15 and 45.
• Having a type of testicular cancer or blood marker results that make spread to the lymph nodes more likely.
• CT scan results showing enlarged lymph nodes in the back of the abdomen.
• A history of an undescended testicle, which raises the risk of testicular cancer.
• A family history of testicular cancer.

When to see a doctor

See a doctor urgently if:

• You have a new lump or swelling in a testicle — see a doctor promptly, even if it does not hurt.
• You have fever, wound problems, leg swelling or severe pain after surgery.
• You cannot pass urine, or you keep vomiting after your operation.
• You feel breathless or have chest pain — call your local emergency number straight away.

Book a routine appointment if:

• You have questions before surgery about what will happen, how long recovery takes, or how it may affect your sex life and fertility.
• You are worried about ejaculation, fertility, or body image — these are important topics and your team can help.
• You notice your energy, appetite or bowel habits are not returning to normal in the weeks after surgery.
• You need advice about going back to work, driving, or exercise.

Diagnosis

RPLND is not a test on its own — it is a treatment step. The decision to do it is based on your cancer diagnosis, blood tests and scans. Your specialist team looks at the type of tumour, the size and position of any enlarged lymph nodes, and how you have responded to any previous treatment. They then talk with you about whether surgery, close monitoring, or further treatment is the best next step for you.

Tests that may be done

• A CT scan of the abdomen and pelvis to look at the lymph nodes.
• Blood tests called tumour markers, which can show cancer activity.
• An ultrasound scan of the scrotum.
• Sometimes a PET scan, which can help show whether tissue is active cancer.
• Routine blood tests to check your kidneys, liver and general health before an anaesthetic.
• A heart and lung check before surgery.
• A discussion about storing sperm before surgery, as this is often recommended.
• Occasionally a biopsy, where a small sample of tissue is taken and checked in the laboratory.

What to expect at your appointment

Before surgery you will meet your surgeon and anaesthetist. They will explain the operation, the risks, and how it might affect you, and you will be asked to sign a consent form. You will usually be asked not to eat or drink for a set number of hours beforehand. On the day, you will be given a general anaesthetic, and you will wake up in a recovery area with a drip, pain relief, and possibly a tube to drain urine and a small drain near the wound. Staff will get you moving gently as soon as it is safe.

Treatment

RPLND is one part of a wider treatment plan for testicular cancer or, less often, another tumour in the same area. For some people with early-stage cancer it may be the main treatment. For others it comes after chemotherapy, to remove what is left behind. Sometimes close monitoring with scans is offered instead of surgery. Your team will explain the choices and what each one means for you.

Self-care at home

• If you smoke, stopping before surgery lowers your risk of chest and wound problems — ask your doctor or pharmacist for help.
• Keep gently active in the weeks before surgery; short daily walks help your body prepare.
• Follow the instructions about when to stop eating and drinking before the operation.
• After surgery, walk a little and often as soon as you are able — this helps your bowels wake up and lowers the risk of clots.
• Support your wound when you cough or laugh, and keep it clean and dry as instructed.
• Avoid heavy lifting, straining and strenuous exercise until your surgeon says it is safe.
• Ask about storing sperm before surgery if you may want children in the future.
• Drink enough fluids and eat fibre-rich foods to help avoid constipation, which can strain the wound.

Medical treatments

Treatment around RPLND may include chemotherapy given before or after surgery, close monitoring with regular scans and blood tests, and support with hormone levels or fertility if needed. Radiotherapy is used for some types of testicular cancer but is not usually part of RPLND treatment. Your specialist team will explain which approach suits your type of tumour and stage, and they will describe the possible benefits and side effects. Always ask your own team before starting or stopping anything, and never take medicines, including over-the-counter ones, without checking with your pharmacist or doctor.

When is surgery considered?

RPLND is done in an operating theatre under general anaesthetic. The surgeon reaches the lymph nodes either through a cut in the middle of the abdomen (open surgery) or through several small cuts using a camera (keyhole surgery). They carefully free the lymph nodes from around the large blood vessels and remove them, and where possible they preserve the nerves that control ejaculation. The tissue removed is sent to a laboratory for testing. You will usually stay in hospital for a few days. Your surgeon will discuss which type of operation is right for you, along with the risks and benefits.

Living with this condition

In the first week or two at home, plan for plenty of rest mixed with short walks. You may feel more tired than you expect, and your appetite can take time to return. Avoid lifting anything heavy, and follow your surgeon's advice about driving, bathing and going back to work. Most people need a few weeks off work, longer if their job is physical. Follow-up appointments with scans and blood tests are an important part of your care — try to keep them, even when you feel well.

Lifestyle tips

• Build activity back gradually — walking first, then gentle strength work once your surgeon agrees.
• Eat regular, balanced meals with plenty of fibre and fluids to keep your bowels comfortable.
• Avoid smoking and keep alcohol within sensible limits to support healing.
• Ask about compression stockings and movement advice to lower the risk of blood clots.
• Keep a simple note of your pain, energy and any new symptoms to bring to appointments.
• Be patient with your body — full recovery often takes a couple of months, not a couple of weeks.

Diet and exercise

There is no special diet that speeds up healing after RPLND, but eating well helps. Aim for regular meals with vegetables, fruit, wholegrains, beans, lean protein and healthy fats, and drink water steadily through the day. Gentle movement, such as short walks several times a day, helps your bowels, your circulation and your mood. Once your wound has healed and your surgeon gives the go-ahead, you can slowly return to sport and heavier exercise. If your appetite stays low or you are losing weight, tell your team.

Mental health and emotional wellbeing

Many people feel anxious or low before and after this kind of surgery, especially when fertility, ejaculation or body image are on their mind. Worry about scans and results is also very common. These feelings are understandable and treatable — talking to your team, a counsellor or a support group often helps a lot. If you feel persistently low, or if you ever have thoughts of harming yourself, please reach out for help right away: contact your local emergency number or a crisis support line in your country, or speak to your doctor. You do not have to cope alone.

Prevention

You cannot prevent needing this operation — it is a treatment, not an illness you can avoid. What you can do is lower the risk of complications. Stopping smoking, keeping as active as you can before surgery, following the fasting instructions, and getting moving gently afterwards all help. Being aware of how your testicles normally look and feel means you are more likely to notice a change early, when treatment is simplest.

Screening programmes

There is no national screening programme for testicular cancer in most countries. Instead, health services encourage men to be aware of what is normal for them and to see a doctor about any new lump or swelling, even if it is painless. After treatment, regular follow-up with scans and blood tests acts as a kind of monitoring, and it is important to attend these appointments.

Complications

If left untreated

• If the cancer that led to the surgery is not treated, it can continue to grow and spread to other parts of the body, such as the lungs, liver or, rarely, the brain.
• Leftover tissue after chemotherapy can grow again if it is not removed and checked.
• Large tumours in this area can press on the bowel, kidneys or blood vessels and cause pain, blockage or kidney problems.
• Surgery also has its own risks, which your surgeon will discuss with you — including bleeding, infection, a temporary slow-down of the bowel, a collection of lymph fluid, blood clots, and changes to ejaculation.

Long-term outlook

The outlook for people who have this surgery is generally good. Testicular cancer is one of the most treatable cancers, and RPLND can be curative for some people and an important step for others. Nerve-sparing surgery means many men keep normal ejaculation, and fertility options can usually be discussed before treatment. Recovery takes time, and there can be set-backs, but most people get back to their normal lives. Your team will keep a close eye on you with follow-up visits and will be there if anything changes.

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