Retroperitoneal Lymph Node Dissection (RPLND)

November 22, 2024

This page was reviewed under our medical and editorial policy by Alexander Chehrazi-Raffle, M.D., assistant professor, Department of Medical Oncology & Therapeutics Research, and Ali Zhumkhawala, M.D., assistant clinical professor, Division of Urology and Urologic Oncology, Department of Surgery, City of Hope^® Cancer Center Duarte

Retroperitoneal lymph node dissection (RPLND) is a surgery to remove lymph nodes. These particular lymph nodes are located in the retroperitoneum, the space at the back of the abdomen, behind the lining of the abdominal wall.

Testicular cancer tends to spread in a predictable way, and it may spread to the retroperitoneal lymph nodes because these lymph nodes are the place that lymphatic fluid from the testicles drains first. Cancer cells may multiply in these lymph nodes before they spread to other areas.

What Is an RPLND?

RPLND is a surgery that removes the retroperitoneal lymph nodes to stage or treat testicular cancer. Removing these lymph nodes is done to help prevent further spread of cancer cells. It is also used to determine if and how much cancer has spread to the lymph nodes, helping to stage testicular cancer.

During RPLND, an incision is made in the front of the abdomen to access the lymph nodes. The surgeon carefully identifies and removes the retroperitoneal lymph nodes while avoiding damage to nearby structures such as nerves and blood vessels, like the aorta and inferior vena cava. RPLND may frequently be performed using a nerve-sparing approach, which preserves the nerves responsible for ejaculation. This may help improve sexual function and preserve fertility. However, in some cases, nearby nerves may need to be removed as well.

Chemotherapy may be a part of treatment before or after RPLND, but RPLND may lead to more complications for people having it after chemotherapy.

Laparoscopic RPLND

Robot-assisted laparoscopic RPLND is a newer technique using smaller incisions and robotic instruments that are controlled by the surgeon. The advantage of this technique is faster recovery and a shorter hospital stay. It is still a complex procedure and should be performed by a surgeon with experience in these types of surgeries.

RPLND Recovery

For the first several days after RPLND, prescription pain medication may be needed, but it may be stepped down over time and swapped for over-the-counter pain relievers after a few weeks.

Full recovery may take up to six weeks, and people who have had RPLND should limit physical activity during their recovery time.

Retroperitoneal Lymph Node Dissection Side Effects

RPLND, like all surgeries, comes with some risks. One of the most common complications is bleeding during the procedure that requires a transfusion.

Other possible risks after surgery may include:

• Blood clots
• Internal scarring affecting the bowels
• Hernia
• Changes in digestive function

Because RPLND is performed close to many nearby complex nerves, there is a chance of nerve injury during the procedure. Some of these nearby nerves affect how sperm is released through ejaculation during orgasm. In some cases after nerve injury, ejaculate may go back into the bladder instead of being released through the urethra from the penis. This is called retrograde ejaculation, or dry ejaculate, and it is not harmful but affects fertility. In laparoscopic RPLND, the chance of retrograde ejaculation as a complication is low.

Sperm Banking

Some men consider banking their sperm before RPLND because if the nerves controlling ejaculation are damaged during the procedure, it may impact their ability to ejaculate and potentially have children in the future. By storing sperm beforehand, individuals have a chance to preserve their fertility and plan for having children later on.

Sperm banking involves providing semen samples through ejaculation or — if a person is not able to ejaculate — a procedure to collect semen or sperm samples. These samples are tested for sperm count and other characteristics and then frozen for future use. Keep in mind that sperm banking might not be an option for people with very fast-growing cancers, and it may be costly, averaging about $1,500 to $2,500 for three years.