Surgery

Removing lymph nodes for testicular cancer (retroperitoneal lymph node dissection)

You might have surgery to remove lymph nodes in your tummy (abdomen). These are called the retroperitoneal lymph nodes. This operation is called a retroperitoneal lymph node dissection.

This is a large operation. You might be in hospital for around 5 days depending on your recovery.

What are retroperitoneal lymph nodes?

form a network of glands throughout your body. Cancer can spread to the lymph nodes and make them bigger (enlarged).

Testicular cancer can spread to the lymph nodes in the back of the tummy (retroperitoneal lymph nodes). They are just in front of your spine.

Diagram showing retroperitoneal lymph nodes.

When do you have it?

Your doctor will talk to you about whether or not you need this surgery. This depends on several factors including your type and of testicular cancer.

You might have this surgery:

if scans show that your lymph nodes are still larger than they should be after chemotherapy
as your main treatment instead of chemotherapy for stage 2A non seminoma cancer, if your aren't raised
if for some reason you can't have chemotherapy or monitoring (surveillance)

What happens

This is a large operation. You have the operation in a specialist centre. You might have a team of different types of surgeons doing the operation. This might include a urologist and a vascular surgeon.

You have this surgery under a general anaesthetic. It can take between 3 and 7 hours.

Open surgery

You usually have open surgery if you have this operation after chemotherapy treatment.

The surgeon makes a long cut in the tummy. The cut is from just below your rib cage to below your belly button.

Keyhole surgery

You might be able to have keyhole surgery if you haven’t had chemotherapy. But this isn't very common. Keyhole surgery is also called laparoscopic surgery. The surgeon usually uses a robotic system to help with keyhole surgery.

It means you don’t need a long cut in your tummy. Instead, the surgeon makes several small cuts in your tummy.

Getting the results

Your surgeon sends the tissue they remove to the laboratory. A specialist doctor (pathologist) examines the tissue. It can take a couple of weeks to get the results.

Your doctor will discuss the results of your surgery at the multidisciplinary team (MDT) meeting. They will then talk to you about your treatment plan.

Your surgeon will explain this to you before your operation, so you know what to expect.

After surgery

When you come round after the operation you might be in a high dependency unit (HDU) or intensive care unit (ICU). Your nurses will monitor you closely. This is usually only for one night before you move back to your ward.

After your surgery you usually have:

drips (intravenous infusions) to give you fluids until you are eating and drinking again
a tube into your bladder (catheter) to measure how much urine you pass
wound drains to drain any blood or fluid
a nasogastric tube down your nose and into your stomach to drain it and stop you feeling sick

You can usually go home after about 3 to 5 days.

Problems after surgery

This operation can damage nerves that control the release of sperm (ejaculation). This could cause one of the following:

a failure to ejaculate
your sperm to go into your bladder (retrograde ejaculation)

You should still be able to get an erection and have an orgasm. But if you have retrograde ejaculation you won't be able to make someone pregnant by having sexual intercourse. Your doctor will talk to you about sperm banking before surgery.

It is sometimes possible to do an operation called a nerve sparing lymph node dissection to try to stop this happening. This is a highly specialised operation and you might need to travel to a specialist hospital to have it. But it is not always possible to do it if there is cancer close to the nerve pathways. Leaving the nerves behind could increase the risk of the cancer coming back.

Treatment for testicular cancer

You usually have surgery. You might have chemotherapy or radiotherapy. This depends on the stage and type of your testicular cancer.

Surgery for testicular cancer

Surgery to remove the testicle is usually the first treatment for testicular cancer. Find out about surgery, and what to expect in hospital and after your operation.