Retroperitoneal lymph node dissection (RPLND)
Retroperitoneal lymph node dissection is surgery to remove the lymph nodes where testicular cancer usually spreads (metastasizes). These lymph nodes are located around the:
- Aorta (major blood vessel)
- Inferior vena cava (major blood vessel)
- Back of the abdomen
Surgeons perform RPLND after orchiectomy. It is a standard treatment for stage I and stage II nonseminomas, one type of testicular cancer. It is also commonly used after chemotherapy for NSGCT. Nonseminomas typically grow faster than seminomas.
Not everyone needs this surgery. Our testicular cancer experts pool their expertise to make the most appropriate treatment recommendation for you. We walk you through the potential benefits and risks of retroperitoneal lymph node dissection — and any treatment alternatives — so you can make informed decisions about your care.
RPLND does not affect a male’s ability to have erections and intercourse. But there is a risk of damage to the nerves that control ejaculation.
If these nerves are damaged, you may experience a condition called retrograde ejaculation. Retrograde ejaculation is when the semen goes back into the bladder instead of out of the penis. This condition can affect your ability to produce children.
Nerve-sparing RPLND can prevent this complication.
If you have metastatic testicular cancer, your treatment plan may include orchiectomy and adjuvant chemo. If these treatments don’t get rid of all the cancer, you may also need chemotherapy after retroperitoneal lymph node dissection to remove the remaining tumors.
When testicular cancer spreads, it follows a predictable pattern. Some patients may need more than one operation to remove tumors located in the:
- Retroperitoneum (located in the back of the abdomen)
- Abdomen
- Chest
- Neck
While these surgeries can cure metastatic testicular cancer, they are highly complex. Removing the cancer often involves other important organs and body structures, including major blood vessels. Many other hospitals don’t have the expertise to perform these challenging procedures.
As a Testicular Cancer Center of Excellence, our urologic surgeons have the rare skill and experience to perform these procedures. They work with other Penn Medicine specialists when needed, including experienced surgeons in our post-chemotherapy surgical team. This level of collaboration leads to fewer complications and better results.