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Retroperitoneum

Procedure

Retroperitoneal Lymph Node Dissection

Surgical removal of lymph nodes in the back of the abdomen (retroperitoneum) is called retroperitoneal lymph node dissection. It is most often performed to stage and treat testicular cancer that may have spread to the retroperitoneal lymph nodes.

What happens before the procedure?

  • Dr. Raghunath will work with you to understand which medications are you taking like blood thinners, prescription medications, OTC drugs and any dietary supplements, etc. Doctor will advise you to avoid alcohol and stop smoking few days before surgery to prevent any complications from happening. Before your surgery, you’ll have an appointment for presurgical testing in which Dr. Raghunath’s team will review your medical and surgical history with you. You may have tests, such as an electrocardiogram to check your heart rhythm, a chest x-ray, blood tests, and any other tests needed to plan your care.

 

What happens during retroperitoneal lymph node dissection?

  • Retroperitoneal lymph node dissection is a long and difficult surgery usually performed under general anesthesia. Dr. Raghunath will either perform it by open method or laparoscopic depending on your medical fitness. He will try to conduct a nerve-sparing procedure, which may save you from side effects like retrograde ejaculation in men. Depending on the cancer spread, doctor will remove the retroperitoneal lymph nodes on the same side of the abdomen as the tumour or on both sides of the abdomen. The surgeon places a small drain and closes the cut with stitches or staples. A drainage bag is attached to the end of the tube to collect fluid draining from the area. This will be kept for a few days until there is little or no drainage.

 

What happens after the procedure?

  • You will be in hospital for about 5-7 days after surgery. The removed lymph nodes and tissues will be sent to a lab for checking. You will be given antibiotics to prevent infection, pain-relieving medicine. Before discharge, Dr. Raghunath and his team will give instructions on caring for and dressing the wound, advice on how much and which types of activity you can do after surgery, and information about which symptoms and side effects you should report. You will be asked to come for a follow-up appointment in 1–2 weeks.

 

What risks are associated with retroperitoneal lymph node dissection?

Like with any procedure, there are few risks. The complication rate for a primary RPLND is about 5% and about 15% for a post-chemotherapy RPLND. Serious complications are rare (less than 2%) and include:

  • Anejaculation
  • Serious bleeding requiring blood transfusion
  • Lymphatic leak (chylous ascites)

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Frequently Asked Questions

  • Why is retroperitoneal lymph node dissection done?
    Apart from staging and treating testicular cancer, this procedure is done to find out if cancer has spread from where it started (primary site) to the retroperitoneal lymph nodes. It is also done to remove lymph nodes that may contain cancer and reduce the chance that cancer will recur. Retroperitoneal lymph node dissection treats cancer that has come back.
  • What are the advantages of laparoscopic retroperitoneal lymph node dissection?
    There are many advantages of undergoing minimally invasive RPLND:
    • Shorter hospital stay and recovery
    • Avoidance of a post-chemotherapy RPLND
    • The rates of anejaculation after unilateral, template RPLND are 5% or less.
    • How successful is retroperitoneal lymph node dissection in treating my testicular cancer?
  • What are the side effects of this procedure?
    Side effects associated with retroperitoneal lymph node dissection are:
    • Pain, discomfort or tenderness in the lower abdomen
    • Inability to pass gas or have a bowel movement or both
    • Pus coming from the incision
    • Semen goes inside the body instead of coming out (retrograde ejaculation)
    • Fertility problems in men, which may be related to retrograde ejaculation
    • A bulge at or near the incision (incisional hernia)
  • How successful is retroperitoneal lymph node dissection in treating my testicular cancer?
    Researchers have reported 5-year overall survival rates of 94.2% for those receiving first-line retroperitoneal lymph node dissection, and 89% for those receiving retroperitoneal lymph node dissection following chemotherapy