Retroperitoneal Lymph Node Dissection (RPLND)

What is a retroperitoneal lymph node dissection?

Retroperitoneal lymph node dissection (RPLND) is a surgical procedure to remove lymph nodes from your body’s retroperitoneal section — a space behind the organs in your belly. Lymph nodes are small organs that help keep your immune system healthy. You have hundreds of them throughout your body.

After your surgical oncologist removes the nodes, a pathologist takes them apart (dissects) to study them. You might also hear healthcare providers refer to this procedure as a retroperitoneal lymphadenectomy.

Why do I need an RPLND?

Your surgeon may do an RPLND to:

• Stage the cancer. Once your surgeon removes your lymph nodes, they send them to a lab. Scientists in the lab cut the nodes into small pieces. They look at the nodes under a microscope to decide the cancer stage. Your surgeon may do this procedure to stage cancer. This is how much the cancer has spread throughout your body.
• Stop cancer from spreading. If cancer has spread to your lymph nodes, it can travel to other parts of your body through your lymphatic vessels. Removing your lymph nodes during an RPLND can help stop cancer from spreading (metastasizing).
• Reduce the chance that cancer will come back (recur). Removing cancerous lymph nodes improves your chances of staying cancer-free.
• As part of cancer treatment if cancer has come back. Your surgeon will remove lymph nodes if cancer returns.

If you have testicular cancer, your surgeon may use an RPLND to stage and treat it at the same time. They may do one to diagnose and treat other kinds of cancer like kidney cancer, cancer in certain reproductive organs and certain sarcomas.

How does my provider know I need an RPLND?

They may do this procedure if imaging tests detect swollen lymph nodes in your retroperitoneal section. Imaging tests may include:

• CT scan
• MRI scan
• PET scan

Your surgeon may suggest this procedure at other points in your journey with cancer. They’ll explain why they recommend an RPLND. They know your situation and they’re the best person to answer this question.

How do surgeons perform a retroperitoneal lymph node dissection (RPLND)?

You’ll be asleep (under general anesthesia) and won’t feel any pain. Your surgeon will make a cut (incision) into your belly to remove the lymph nodes closest to the cancer.

The main goal of retroperitoneal lymph node dissection is to remove all cancerous cells so that they don’t spread. Your surgeon may need to remove more than your lymph nodes to accomplish this goal. They may:

• Remove additional lymph nodes from another part of your body
• Remove another organ, like one of your kidneys
• Remove other masses in the area

Your surgeon may do laparoscopic surgery or robotic surgery to do this procedure. They’ll explain the procedures and discuss whether they’re appropriate for you.

An RPLND can take three to 10 hours to complete.

What should I expect after the procedure?

You can expect to stay in the hospital for four to seven days after your surgery. You may have some pain after surgery. Your healthcare provider will prescribe pain medication. They may recommend pain management support.

What are the risks of this procedure?

RPLND has several risks, including:

• Damage to your blood vessels. Because your surgeon will be working with (and close to) several large blood vessels, there’s a risk of cutting them, causing additional bleeding.
• Fertility concerns. People assigned male at birth (AMAB) may have issues with ejaculation after this procedure. This can happen because the nerves that control ejaculation run through this area. Often, surgeons can protect these nerves, but anejaculation (inability to ejaculate semen ) is possible.
• Lymphocele. Fluid can collect in the space where your surgeon removed your lymph nodes. Your surgeon can place a drain in your belly to help get rid of this extra fluid.
• Post-surgery complications. You may experience complications like infection, respiratory problems, damage to other organs, pain in your lower belly and constipation.

What type of results do you get after retroperitoneal lymph node dissection?

Your surgeon will explain the pathology results. They may use terms like positive or negative to describe them. A positive result means there’s cancerous cells in your lymph nodes. A negative result means there aren’t any. Your pathologist will note the number of positive nodes among all the lymph nodes that your provider removed.

They may also note:

• The type of cancer
• The grade (how the cancerous cells look when compared to normal cells)
• The mitotic rate (how quickly the cancerous cells divide)

When should I know the results of the RPLND?

The lab usually takes one to two weeks to deliver the results to your surgeon. They’ll let you know the results and what the results mean.

What are the next steps after I get the results?

The next steps may include:

• Observation (surveillance)
• Chemotherapy
• Radiation therapy

When should I call my doctor?

You should call your doctor immediately if your incision isn’t healing or there are signs of infection, including:

• Nausea or vomiting where you can’t keep down fluids
• Pain, tightness or tenderness in your lower belly
• Being unable to can’t pass gas or poop
• Pus coming from your incision
• Severe pain that can’t be managed

What is the retroperitoneum?

The retroperitoneum is the area of your abdomen behind your peritoneum. It contains urinary, digestive or vascular system organs.

What kind of cancers spread to retroperitoneal lymph nodes?

The following types of cancer may spread to the retroperitoneal lymph nodes:

• Cervical
• Colon
• Esophageal
• Liver
• Ovarian
• Pancreatic
• Prostate
• Rectal
• Stomach
• Testicular

What are enlarged retroperitoneal lymph nodes?

Enlarged retroperitoneal lymph nodes are swollen lymph nodes in the retroperitoneal space. They’re usually 10 millimeters (about ½ inch) or larger.

Can enlarged retroperitoneal lymph nodes cause back pain?

They can. Swollen retroperitoneal lymph can cause pain that spreads through your lower back. They may also cause belly pain and bloating. You should talk to a healthcare provider if you have these symptoms.