Careful patient selection, precise surgery and a personalised approach to treatment.
In testicular cancer, some patients may need further treatment after the tumour in the testicle has been removed. One of these is RPLND, an operation in which the lymph nodes at the back of the abdomen are removed. The aim is to remove the lymph nodes to which cancer cells can spread and, where necessary, any tumour masses in this area.
Lymph nodes are like small checkpoints of the body’s defence system. Lymphatic drainage from the testicles reaches the lymph nodes around the major blood vessels inside the abdomen, and cancer cells can also spread to this area.
The area where RPLND is performed lies behind the peritoneum, the membrane lining the abdominal cavity, close to the kidneys and the major blood vessels. In suitable patients, the operation helps both to determine the spread of the disease and to treat it.
RPLND is not performed on every patient with testicular cancer. The decision is personalised according to the characteristics of the disease.
After removal of the testicle, RPLND may be considered in selected patients depending on the type of disease and its risk features. Examining the removed lymph nodes helps determine the spread of the disease and the next treatment plan.
Masses remaining after chemotherapy may not contain only dead tissue; they may contain viable tumour or teratoma, which does not respond adequately to chemotherapy. Particularly in non-seminoma, surgery is considered for residual masses larger than 1 cm once tumour markers have normalised.
The lymph nodes to be removed lie in close proximity to the aorta, the vena cava, the renal vessels and the ureters. After chemotherapy, tissues can harden and adhere to surrounding structures, which may make the operation more complex.
Experience covers not only performing the operation but also identifying which patients will benefit, choosing the right method and, when necessary, working together with other surgical specialties.
The camera and surgical instruments are inserted through small incisions. In robotic surgery too, it is the surgeon who performs the operation and controls every movement.
Small incisions may support recovery in suitable patients. Open surgery may be preferred for large masses or masses that are firmly adherent to surrounding tissues.
The goal is the safe and adequate removal of diseased tissue. A robotic approach is not suitable for every patient; the method is decided through individual assessment.
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Discuss the risks, reproductive health and the follow-up process with your surgeon.
Pathological examination of the removed tissue shows whether further treatment is needed and guides the follow-up plan. Regular check-ups are important.
Possible risks include bleeding, infection, injury to nearby organs or blood vessels, a temporary slowing of bowel movements and a build-up of lymphatic fluid in the abdomen. The risks vary depending on the extent of the operation and previous treatments.
The nerves that allow semen to be ejaculated are located in this area. If these nerves are affected, the amount of semen released at orgasm may decrease or disappear. This is not the same as losing erections; however, it can affect the ability to father a child naturally. Nerve-sparing techniques may be considered in suitable patients.
Plans for having children and the option of sperm freezing should be discussed before treatment begins. Because chemotherapy can affect sperm count and quality, planning is done before chemotherapy whenever possible. For patients who have already been treated, the options are assessed individually.
No. The size of the mass, its relationship to the major blood vessels and surrounding organs, previous treatments and the patient’s general condition are assessed together. Open surgery is preferred when necessary. The priority is the safe and adequate removal of diseased tissue.
You can ask: “Why is RPLND recommended for me?”, “What are my alternatives?”, “Which surgical method is suitable?”, “What are the expected benefits and risks?” and “What can be done to protect my reproductive health?” Your pathology report, blood tests and imaging results help with the assessment.
To learn more about RPLND and robotic surgery or to book an appointment, please contact our clinic.
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