Sometimes the words doctors use when they talk to us can seem a little complicated, right? One such term is ``Retroperitoneal Lymph Node Dissection'' or ``(RPLND)''. Simply put, this refers to a surgery that removes the lymph nodes that are located inside your abdomen, a little behind it. This is often done in cases of cancer. So, let's talk about this in a little more detail, shall we?
What is RPLND? Let's understand exactly!
Okay, first let's look at what this `(Retroperitoneal section)` is. Imagine, you have organs like your liver and intestines inside your abdomen, and this is the space behind them, towards your spine. That space is where you have little glands called lymph nodes . These lymph nodes are little sentinels that help our immune system a lot and help protect us from diseases. There are hundreds of these all over the body.
Now, in an RPLND, your surgical oncologist removes some of the lymph nodes in this area called the retroperitoneal lymph node. Then, a pathologist takes the removed lymph nodes, dissects them, and examines them under a microscope. This is how a lot of things can be determined, such as whether there are any cancer cells present and how far they have spread. You may have heard this called a retroperitoneal lymphadenectomy.
Why would you want to have RPLND surgery? There could be several reasons!
If a doctor suggests this type of surgery for you, there could be several reasons. Let's take a look at the main ones:
- Know the exact stage of the cancer: When the removed lymph nodes are sent to the lab, scientists there look at them carefully and determine the stage of the cancer. This helps to know exactly how far the cancer has spread in the body.
- Stop the cancer from spreading further: Imagine that cancer cells have reached the lymph nodes. Then they can travel through the lymph vessels to other parts of the body. So, removing these lymph nodes with `(RPLND)` surgery will help a lot in stopping the cancer from spreading further (`(metastasizing)`).
- Reduce the risk of cancer coming back: Removing lymph nodes that contain cancer cells increases your chances of remaining cancer-free. That is, the risk of the cancer coming back (`(recur)`) is reduced.
- As a treatment if the cancer comes back: Sometimes, if the cancer comes back, these lymph nodes are also removed as a treatment.
Especially if you have testicular cancer , doctors can use RPLND to quickly stage and treat the cancer. It is also used to diagnose and treat other types of cancer, such as kidney cancer, some reproductive system cancers, and some sarcomas.
How does the doctor know if an RPLND is needed?
Before your doctor suggests this surgery, he or she will usually do some special tests to check for swelling in your retroperitoneal lymph nodes. These are called imaging tests. For example:
- CT scan (`(CT scan)`)
- MRI scan (`(MRI scan)`)
- PET scan (`(PET scan)`)
If these tests show any changes in your lymph nodes, or at any other point in your cancer journey, your doctor may suggest a ``RPLND'' surgery. He or she will explain to you why this surgery is recommended because he or she knows your situation well.
How is RPLND surgery performed? Let's take a look in detail.
During this surgery, you will be put under general anesthesia . This means you will not feel any pain and will be asleep. Then, the surgeon will make a small incision in your abdomen and remove the lymph nodes closest to the cancer.
The main goal of this surgery is to remove all the cancer cells so that they don't spread further. To achieve this goal, the surgeon may sometimes have to remove more than just the lymph nodes. For example:
- Additional lymph nodes elsewhere in the body.
- Another organ, like a kidney.
- Other tumors or masses in that area.
Sometimes this surgery can be done laparoscopically or using robotic surgery . This means that instead of making a large incision, a camera and delicate instruments are inserted through several small incisions. Your surgeon will explain to you which method is right for you and what the advantages and disadvantages are.
This ``(RPLND)`` surgery can take about three to ten hours to complete.
What to expect after surgery?
You will need to stay in the hospital for about four to seven days after the surgery. You may have some pain after the surgery. Your doctor will prescribe pain medication for this. You may also be given special instructions (`(pain management support)`) to help manage the pain.
Remember, don't be afraid to tell the doctor or nurse about any discomfort you feel after surgery. They can then help you.
What are the risks of this surgery?
As with any surgery, RPLND surgery carries some risks, and it is important to be aware of them.
- Damage to blood vessels: Because the surgeon works very close to large blood vessels, they can sometimes be slightly damaged, causing additional bleeding.
- Fertility concerns: There may be some problems with ejaculation after this surgery. This is because the nerves that control ejaculation run through this area. Although surgeons often try to protect these nerves, sometimes a condition called anejaculation can occur. It is a good idea to discuss this with your doctor before surgery.
- Lymphatic fluid accumulation (Lymphocele): Lymphatic fluid can accumulate in the space where the lymph nodes were removed. The surgeon may place a small tube (drain) in your abdomen to drain this excess fluid.
- Possible complications after surgery: Infection, difficulty breathing, damage to other organs, lower abdominal pain, and constipation may occur.
Your doctor will tell you more about these risks. Don't worry, not all of these things happen to everyone.
What are the results after RPLND surgery?
Your surgeon will explain the pathology results to you. He or she may use words like "positive" or "negative."
- A positive result means there are cancer cells in your lymph nodes.
- A negative result means there are no cancer cells.
The pathologist will also note in the report how many cancer cells were found in the total number of lymph nodes removed. In addition, several other things may be mentioned in this report:
- Type of cancer (`(type of cancer)`)
- The severity/grade of the cancer (that is, how different the cancer cells are compared to normal cells)
- The rate at which cancer cells divide (`(mitotic rate)`)
How long does it take to know the results?
It usually takes a week or two for the lab to give the results to the surgeon. Once the results are in, he or she will call you and explain what they mean.
What happens next after the results are received?
The results will determine what to do next. This may include:
- Observation (`(Observation/surveillance)`): Sometimes no treatment is given, but continued observation is done.
- Chemotherapy: Giving drugs to kill cancer cells.
- Radiation therapy: The use of high-energy rays to destroy cancer cells.
Your medical team will discuss with you and decide what treatment plan is best for you.
When should I call the doctor as soon as possible?
After surgery, if your incision is not healing properly or if you have signs of infection , you should call your doctor immediately . These are some of the signs:
- Vomiting or nausea (to the point of not being able to keep down even liquids)
- Lower abdominal pain, tenderness, or tenderness to the touch
- Inability to pass air or defecate
- Pus draining from the cut
- Severe pain that cannot be controlled with medication
If you see something like this, definitely tell your doctor .
Let's learn a little more about this retroperitoneum.
As we mentioned earlier, the ``retroperitoneum'' is the space inside your abdomen, behind your other organs. This is where some of the organs of the urinary system, digestive system, or circulatory system are located.
What types of cancer spread to these lymph nodes (retroperitoneal lymph nodes)?
Many types of cancer can spread to these (retroperitoneal) lymph nodes. Some examples are:
- Cervical cancer (`(Cervical cancer)`)
- Colon cancer (`(Colon cancer)`)
- Esophageal cancer
- Liver cancer
- Ovarian cancer (`(Ovarian cancer)`)
- Pancreatic cancer (`(Pancreatic cancer)`)
- Prostate cancer (`(Prostate cancer)`)
- Rectal cancer
- Stomach cancer (`(Stomach cancer)`)
- Testicular cancer (`(Testicular cancer)`)
What are enlarged retroperitoneal lymph nodes?
Simply put, this means that the lymph nodes in the ``retroperitoneal`` space are swollen and enlarged. This is usually when they are 10 millimeters (about half an inch) or larger.
Can these lymph nodes cause back pain when they swell?
Yes, you can. Swollen (retroperitoneal) lymph nodes can cause pain that radiates down your lower back. They can also cause symptoms like abdominal pain and bloating. If you have any of these symptoms, be sure to see a doctor.
Finally, things to remember
Any surgery, especially one related to cancer, can be scary. An RPLND is a procedure to check your retroperitoneal lymph nodes for cancer. The results of this procedure can help your medical team make important decisions about your care.
Talk openly and honestly with your medical team. Ask any questions you have about the surgery, the recovery time, or any part of your care. Also, if you still feel unsure about having such a major surgery, there's nothing wrong with getting a ``second opinion'' . Talking to another doctor may help you feel more comfortable about having the surgery.
Having this surgery is a big step, but it could save your life. Your medical team is here to answer your questions and support you.
` Cancer, Surgery, Lymph Nodes, RPLND, Retroperitoneal, Health, Medical Information
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