Retroperitoneal Lymph Node Dissection

From Wikipedia, the free encyclopedia

Retroperitoneal Lymph Node Dissection, commonly referred to as RPLND, is a procedure to remove abdominal lymph nodes to treat Testicular Cancer, as well as help establish its exact maturity and type.

Testicular Cancer spreads in a well-known pattern, and the lymph nodes in the retroperitoneum are a primary landing site during spread of the disease.

The procedue is becoming standard treatment for clinical stage I and II Non-Seminomatous Germ Cell Tumors (NSGCTT) because of the low mortality and relapse rate with this procedue, as compared with the alternative, which is observation. Also, NSGCTT is considered more aggressive than Seminomas, the "other" kind of Testicular Cancer.

The potential problems in RPLND have mostly to do with nerves: they might get damaged or cut resulting in infertility, an inability to ejaculate, or the inability to have an erection. This is why most often, a nerve-sparing technique is used. A less invasive form using laparoscopic technique (L-RPLND) exists, which is more costly, time-consuming, and requires special equipment that not every hospital may have. Open RPLND (O-RPLND), which is performed by opening the stomach to get inside, has more room for problems, but is an equally effective way to get the lymph node out.

There are different schools of thought about the need to perform RPLND after orchiectomy, and it depends on the type of tumor, and what stage it is in. Most American Doctors recommend surgery, whereas in Europe, chemotherapy is more often used.

Chemotherapy before RPLND is considered an effective approach, because it is possible that it suffices and no relapse occurs. But in case the cancer does come back, chemotherapy complicates surgery. THis is also why most doctors will recommend RPLND.