Retroperitoneal lymph node dissection (RPLND) is a

surgical procedure Surgery is a medical specialty that uses manual and instrumental techniques to diagnose or treat pathological conditions (e.g., trauma, disease, injury, malignancy), to alter bodily functions (e.g., malabsorption created by bariatric surgery s ...

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 an c ...

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

Indications

Testicular cancer metastasizes 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 disease. 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 the context of modern medical treatme ...

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 ( testes) is the gonad in all male bilaterians, including humans, and is Homology (biology), homologous to the ovary in females. Its primary functions are the production of sperm and the secretion of Androgen, androgens, p ...

. The procedure is common in the treatment of Stage I and II non-seminomatous germ cell tumors. In

seminoma A seminoma is a germ cell tumor of the testicle or, more rarely, the mediastinum or other extra-gonadal locations. It is a Malignancy, malignant neoplasm and is one of the most treatable and curable cancers, with a survival rate above 95% if di ...

s, another form of testicular cancer,

radiation therapy Radiation therapy or radiotherapy (RT, RTx, or XRT) is a therapy, treatment using ionizing radiation, generally provided as part of treatment of cancer, cancer therapy to either kill or control the growth of malignancy, malignant cell (biology), ...

is generally preferred to the invasive RPLND procedure. Whether RPLND is needed after

orchiectomy Orchiectomy (also named orchidectomy) is a surgery, surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons: *treatment for testicular cancer *as part of gender-affirming surgery for trans ...

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 (: sternums or sterna) 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 bl ...

to several inches below the

navel The navel (clinically known as the umbilicus; : umbilici or umbilicuses; also 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. Structure The u ...

. 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 running parallel to the

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

, 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, inhibiting urination and preventing a reflux of semen ...

and

infertility In biology, infertility is the inability of a male and female organism to Sexual reproduction, reproduce. It is usually not the natural state of a healthy organism that has reached sexual maturity, so children who have not undergone puberty, whi ...

. In most cases nerve sparing is feasible leading to reduced rates of retrograde ejaculation. However, prior chemotherapy or very large residual masses may make nerve sparing challenging.Donohue, John P., and Richard S. Foster. "Retroperitoneal lymphadenectomy in staging and treatment: the development of nerve-sparing techniques." Urologic Clinics of North America 25.3 (1998): 461-468. Contrary to popular belief,

erectile function An erection (clinically: penile erection or penile tumescence) is a physiological phenomenon in which the penis becomes firm, engorged, and enlarged. Penile erection is the result of a complex interaction of psychological, neural, vascular, a ...

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 tissue (biology), tissues by pathogens, their multiplication, and the reaction of host (biology), host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmis ...

is a possibility, as are

bowel obstruction Bowel obstruction, also known as intestinal obstruction, is a mechanical or Ileus, functional obstruction of the Gastrointestinal tract#Lower gastrointestinal tract, intestines which prevents the normal movement of the products of digestion. Ei ...

s and adhesions.

References

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