Retroperitoneal lymph node dissection (RPLND) is a

surgical procedure Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pa ...

to remove abdominal

lymph node A lymph node, or lymph gland, is a kidney-shaped organ of the lymphatic system and the adaptive immune system. A large number of lymph nodes are linked throughout the body by the lymphatic vessels. They are major sites of lymphocytes that includ ...

s. It is used to treat

testicular cancer Testicular cancer is cancer that develops in the testicles, a part of the male reproductive system. Symptoms may include a lump in the testicle, or swelling or pain in the scrotum. Treatment may result in infertility. Risk factors include a ...

, as well as to help establish the exact stage and type of the cancer.

Indications

Testicular cancer

metastasizes Metastasis is a pathogenic agent's spread from an initial or primary site to a different or secondary site within the host's body; the term is typically used when referring to metastasis by a cancerous tumor. The newly pathological sites, the ...

in a predictable pattern, and lymph nodes in the

retroperitoneum The retroperitoneal space (retroperitoneum) is the anatomical space (sometimes a potential space) behind (''retro'') the peritoneum. It has no specific delineating anatomical structures. Organs are retroperitoneal if they have peritoneum on their ...

are typically the first place it lands. By examining the removed lymphatic tissue, a

pathologist Pathology is the study of the causes and effects of disease or injury. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in th ...

can determine whether the disease has spread. If no malignant tissue is found, the cancer can be labeled Stage I, limited to the

testicle A testicle or testis (plural testes) is the male reproductive gland or gonad in all bilaterians, including humans. It is homologous to the female ovary. The functions of the testes are to produce both sperm and androgens, primarily testoste ...

. The procedure is common in the treatment of Stage I and II non-seminomatous germ cell tumors. In seminomas, another form of testicular cancer,

radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Rad ...

is generally preferred to the invasive RPLND procedure. Whether RPLND is needed after orchiectomy depends on the type of tumor and its stage. RPLND may be performed to remove tumor remnants that persist after chemotherapy, because these remnants might otherwise spread and become resistant to the chemotherapy agents previously used. Chemotherapy may be administered before RPLND and, if successful, may render surgery unnecessary. However, if the cancer does recur, surgery is much more difficult in a patient previously treated with chemotherapy.

Procedure

RPLND is usually performed using an incision that extends from the

sternum The sternum or breastbone is a long flat bone located in the central part of the chest. It connects to the ribs via cartilage and forms the front of the rib cage, thus helping to protect the heart, lungs, and major blood vessels from injury. Sha ...

to several inches below the

navel The navel (clinically known as the umbilicus, commonly known as the belly button or tummy button) is a protruding, flat, or hollowed area on the abdomen at the attachment site of the umbilical cord. All placental mammals have a navel, altho ...

. A less invasive procedure (L-RPLND) can be performed laparoscopically, but this is more costly and time-consuming, and requires specialized equipment that not every hospital has. Additionally, it is unclear whether L-RPLND is as effective as the standard, open procedure.

Complications

Potential complications of RPLND include damage to the

sympathetic nerves The sympathetic nervous system (SNS) is one of the three divisions of the autonomic nervous system, the others being the parasympathetic nervous system and the enteric nervous system. The enteric nervous system is sometimes considered part of the ...

running parallel to the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the sp ...

, which can result in

retrograde ejaculation Retrograde ejaculation occurs when semen which would be ejaculated via the urethra is redirected to the urinary bladder. Normally, the sphincter of the bladder contracts before ejaculation, sealing the bladder which besides inhibiting the relea ...

and

infertility Infertility is the inability of a person, animal or plant to reproduce by natural means. It is usually not the natural state of a healthy adult, except notably among certain eusocial species (mostly haplodiploid insects). It is the normal st ...

. Contrary to popular belief, erectile function is not compromised by RPLND because the nerves responsible for erection are located elsewhere. As with any major surgery,

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable di ...

is a possibility, as are

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs ...

s and adhesions.

References

{{Operations and other procedures of the hemic and lymphatic system Surgical oncology Lymphatic organ surgery