Surgical procedure to remove abdominal lymph nodes
Retroperitoneal lymph node dissection
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Specialty
| Hematology
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Retroperitoneal lymph node dissection
(RPLND) is a
surgical procedure
to remove abdominal
lymph nodes
. It is used to treat
testicular cancer
, as well as to help establish the exact
stage
and type of the cancer.
Indications
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Testicular cancer
metastasizes
in a predictable pattern, and lymph nodes in the
retroperitoneum
are typically the first place it lands.
[1]
[2]
By examining the removed lymphatic tissue, a
pathologist
can determine whether the disease has spread. If no malignant tissue is found, the cancer can be labeled Stage I, limited to the
testicle
.
[3]
The procedure is common in the treatment of Stage I and II
non-seminomatous germ cell tumors
.
[2]
In
seminomas
, another form of testicular cancer,
radiation therapy
is generally preferred to the invasive RPLND procedure.
[4]
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.
[5]
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.
[2]
Procedure
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RPLND is usually performed using an incision that extends from the
sternum
to several inches below the
navel
. 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.
[6]
Complications
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Potential complications of RPLND include damage to the
sympathetic nerves
running parallel to the
spinal cord
, which can result in
retrograde ejaculation
and
infertility
.
[6]
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.
[7]
Contrary to popular belief,
erectile function
is not compromised by RPLND because the nerves responsible for erection are located elsewhere.
[6]
As with any major surgery,
infection
is a possibility, as are
bowel obstructions
and
adhesions
.
[6]
References
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