Retroperitoneal excision of abdominal lymph nodes

What is this?

This involves removal of the lymph nodes alongside the main blood vessels in the abdomen and usually follows chemotherapy or radiotherapy treatment for testicular cancer

What alternatives are there?

Observation (not recommended). The retroperitoneum is the space behind the gut where the main blood vessels (the aorta and vena cava) run. Lymph nodes are small (French bean-sized) structures which trap cancer cells and may become enlarged. The operation is designed to remove these nodes and is carried out as part of your treatment for testicular cancer. It is normally performed after you have completed chemotherapy; If this does not cause the lymph nodes to shrink to a normal size, there is a possibility that there may be some cells in them which could become cancerous in the future. The only way to know this for sure is to remove these lymph glands and to send them to the laboratory for microscopic examination (histology). In some cases a minimally invasive or laparoscopic approach might be possible.

What to expect before procedure

Although you will have discussed issues of sterility with your urologist or oncologist, it is important to be aware that the nerves which control ejaculation run through the middle of the surgical area. We try to preserve these nerves but there is always a risk of damage because there may be a lot of scar tissue around the nerves after the chemotherapy treatment. This can result in weak or absent ejaculation after the operation and the semen may even be directed back into your bladder instead of coming out through your penis (a "dry" orgasm). This is not, of course, harmful; the semen is flushed away with your urine but, If this does occur, it is very likely that you will be sterile. This does not, however, always happen and you urologist may be able to tell you If it is likely in your case. If you have not already done so, it may be possible for you to store semen as a precaution and you should discuss this with your urologist before the procedure. You will see the urology team in the Uro-Oncology Clinic to discuss the operation in detail and you will usually be admitted on the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. On the day before your operation, you will only be allowed to drink clear fluids such as water, squash, black tea or coffee. You may also be given a laxative to clear your bowel. Immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. A long incision is made in your abdomen to enable the surgeon to access and remove the necessary lymph nodes. The operation normally takes 3-6 hours to perform.

After the procedure

You will be taken from the operating theatre to the recovery area where your condition will be closely monitored until you are awake enough to return to the ward. Some men require observation in the intensive therapy unit (ITU) to allow closer monitoring; visiting times in these areas are flexible and will depend on when you return from the operating theatre. You will have a drip to keep you hydrated, through which you can also be given medication. You will be given separate information about patient-controlled analgesia (PCA) or an epidural anaesthetic which are designed to minimise post-operative pain. You will be given oxygen via a mask or nasal spectacles. A catheter is usually inserted into the bladder and a dressing will cover your wound; the wound itself is usually closed with staples which are removed after 7-10 days. You will receive physiotherapy, starting on the day after the operation, to encourage mobility, deep breathing and leg movements. You can usually start drinking water 2-3 days after the procedure and, once bowel activity has returned, you will be able to drink and eat freely. The average hospital stay is 9 days.

Potential side effects