What is Retroperitoneal Lymph Node Dissection for Testicular Cancer

Retroperitoneal lymph node dissection (RPLND) is a surgery that is done to treat cancer of the testicle (testicular cancer). In this surgery, the retroperitoneal lymph nodes are removed. Lymph nodes are part of the body’s defense system (immune system) and they help to filter out substances. The retroperitoneal lymph nodes are located behind the organs in the abdomen.

Testicular cancer affects the testicles in men. If testicular cancer spreads (metastasizes), it usually spreads to the retroperitoneal lymph nodes. Removing these lymph nodes helps to treat testicular cancer that has metastasized.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines.
• Damage to other organs or structures, such as nerves.
• Scarring.
• Inability to produce sperm (infertility).
• Pain.
• Problems with breathing.
• Problems with bowel movements.
• Blockage in the intestines (bowel obstruction).
• Problems with ejaculation, such as sperm going into the bladder instead of the penis (retrograde ejaculation).
• Fluid collecting in the area where the lymph nodes used to be.

What happens before the procedure?

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

• Follow instructions from your health care provider about eating and drinking, which may include:
  • 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
  • 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
  • 6 hours before the procedure – stop drinking milk or drinks that contain milk.
  • 2 hours before the procedure – stop drinking clear liquids.
• Avoid drinking alcohol.

Medicines

• Ask your health care provider about:
  • Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
  • Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines before your procedure if your health care provider instructs you not to.
• You may be given antibiotic medicine to help prevent infection. Take it as told by your health care provider.

General instructions

• You may need to collect your sperm in a sperm bank because this procedure can affect your ability to produce sperm (fertility). Ask your health care provider if this is necessary.
• You may be instructed to perform an enema to clean out your bowel in preparation for surgery (bowel prep). If so:
  • Follow instructions from your health care provider about how to do this.
  • Follow any restrictions about eating or drinking after you have performed the enema.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Plan to have someone take you home from the hospital.
• Ask your health care provider how your surgical site will be marked or identified.
• You may be asked to shower with a germ-killing soap.

What happens during the procedure?

• To reduce your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Your skin will be washed with soap.
  • Hair may be removed from the surgical area.
• An IV tube will be inserted into one of your veins.
• You will be given one or more of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A thin, flexible tube (catheter) will be inserted to help drain your urine. The catheter will stay in for several days.
• An incision will be made in your abdomen. In some cases, a robot-assisted approach will be used, and multiple small incisions will be made instead of one large incision.
• Your organs will be moved aside so it is easier to get to the lymph nodes.
• Your retroperitoneal lymph nodes will be removed.
• Your incision will be closed with stitches (sutures), skin glue, or adhesive strips.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
• You may have to take medicine for pain.
• You may have to wear compression stockings. These help prevent blood clots and reduce swelling in your legs.
• Do not drive for 24 hours if you were given a sedative.

Summary

• Retroperitoneal lymph node dissection (RPLND) is a surgery that is done to treat cancer of the testicle (testicular cancer).
• The retroperitoneal lymph nodes are located behind the organs in the abdomen.
• Follow instructions from your health care provider about eating and drinking before the procedure.
• A thin, flexible tube (catheter) will be inserted to help drain your urine. The catheter may stay in for several days.

Retroperitoneal Lymph Node Dissection for Testicular Cancer, Care After

This sheet gives you information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common to have:

• Pain.
• Mild nausea.
• Poor appetite.
• Tiredness (fatigue).
• Constipation, gas, or cramps in the abdomen.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Driving

• Do not drive for 24 hours if you were given a medicine to help you relax (sedative) during your procedure.
• Do not drive or use heavy machinery while taking prescription pain medicine.

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do not lift anything that is heavier than 10 lb (4.5 kg) or the limit that your health care provider tells you until he or she says that it is safe.

General instructions

• Do not take baths, swim, or use a hot tub until your health care provider approves.
• Follow instructions from your health care provider about eating or drinking restrictions.
• Wear compression garments as told by your health care provider. Compression garments help to prevent blood clots and reduce swelling.
• To prevent or treat constipation while you are taking prescription pain medicine, your health care provider may recommend that you:
  • Drink enough fluid to keep your urine clear or pale yellow.
  • Take over-the-counter or prescription medicines.
  • Eat foods that are high in fiber, such as fresh fruits and vegetables, whole grains, and beans.
  • Limit foods that are high in fat and processed sugars, such as fried and sweet foods.
• Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• Your pain gets worse and medicine does not help.
• You have diarrhea or constipation.
• You have nausea or vomiting.
• You have pain in the back of your lower leg (calf). This can be a sign of a blood clot.
• You have redness, swelling, or pain around your incision.
• You have fluid or blood coming from your incision.
• Your incision feels warm to the touch.
• You have pus or a bad smell coming from your incision.

Get help right away if:

• You have a fever.
• You have problems with breathing.

Summary

• Follow instructions from your health care provider about how to take care of your incision.
• Ask your health care provider when it is safe for you to return to your normal activities.
• Check your incision area every day for signs of infection, such as redness, swelling, pain, fluid, blood, warmth, pus, or a bad smell.
• Keep all follow-up visits as told by your health care provider.