Removing lymph nodes for testicular cancer (retroperitoneal lymph node dissection)
You might have surgery to remove lymph nodes in your tummy (abdomen). These are called the retroperitoneal lymph nodes. This operation is called a retroperitoneal lymph node dissection.
This is a large operation. You might be in hospital for up to 5 days, depending on how you have the surgery.
What are retroperitoneal lymph nodes?
form a network of glands throughout your body. Cancer can spread to the lymph nodes and make them bigger (enlarged).
Testicular cancer can spread to the lymph nodes in the back of the tummy (abdomen). These are called the retroperitoneal lymph nodes. They are just in front of your spine.
When do you have it?
Your doctor will talk to you about whether or not you need this surgery. This depends on several factors including your type and stage of testicular cancer.
You might have this surgery:
- if scans show that your lymph nodes are still larger than they should be after chemotherapy
- as your main treatment instead of chemotherapy for stage 2A non seminoma cancer, if your tumour markers aren't raised
- if for some reason you can't have chemotherapy or monitoring (surveillance)
What happens
This is a large operation. You have the operation in a specialist centre. You might have a team of different types of surgeons doing the operation. This might include a urologist and a vascular surgeon.
You have this surgery under general anaesthetic. It can take between 3 and 7 hours.
Open surgery
You usually have open surgery if you have this operation after chemotherapy treatment.
The surgeon makes a long cut in the tummy (abdomen). The cut is from just below your rib cage to below your belly button.
Keyhole surgery
You might be able to have keyhole surgery if you haven’t had chemotherapy. But this isn't very common. Only a few patients can have this, at specialised hospitals.
Keyhole surgery is also called laparoscopic surgery. The surgeon usually uses a robotic system to help with keyhole surgery.
It means you don’t need a major cut in your tummy (abdomen). Instead, the surgeon makes around 5 small cuts in your tummy.
Getting the results
Your surgeon sends the tissue they remove to the laboratory. A specialist doctor (pathologist) examines the tissue. It can take several weeks to get the results.
Your doctor will discuss the results of your surgery at the multidisciplinary team (MDT) meeting. They will then tell you about your treatment plan.
Your surgeon will explain this to you before your operation, so you know what to expect.
After surgery
When you come round after the operation you might be in a high dependency unit (HDU) or intensive care unit (ICU). Your nurses will monitor you closely. This is usually only for one night before you move back to your ward.
You can usually go home after about 3 to 5 days.
Problems after surgery
This operation can damage nerves that control the release of sperm (ejaculation). This could cause one of the following:
- a failure to ejaculate
- your sperm to go into your bladder (retrograde ejaculation)
You should still be able to get an erection and have an orgasm. But if you have retrograde ejaculation you won't be able to make someone pregnant by having sexual intercourse. Your doctor will talk to you about sperm banking before surgery.
It is sometimes possible to do an operation called a nerve sparing lymph node dissection to try to stop this happening. This is a highly specialised operation and you might need to travel to a specialist hospital to have it. But it is not always possible to do it if there is cancer close to the nerve pathways. Leaving the nerves behind could increase the risk of the cancer coming back.
