When your doctor told you that you had cancer, did he tell you about the RPLND surgery? You may have felt a little scared and overwhelmed by the name. But don't worry. This is actually a very important surgery that is done to stop the spread of cancer cells in your body. So let's talk about it simply, in a way that you can understand.
What is RPLND surgery?
Simply put, RPLND (Retroperitoneal Lymph Node Dissection) is a surgical procedure that removes lymph nodes from a specific area of your body. This area is called the 'retroperitoneal' area.
Think of it this way: the empty space in your abdomen behind your major organs, like your liver and intestines. That area is what we call the retroperitoneal region.
Now let's see what these lymph nodes are. These are actually very small organs that help keep our body's immune system healthy. They're like the sentinels of our body. There are hundreds of them scattered throughout our bodies.
So, after your surgeon (surgical oncologist) removes the lymph nodes during this surgery, they send them to a pathologist for examination. There, they look at the lymph nodes under a microscope to see if there are any cancer cells. Doctors sometimes call this surgery a 'retroperitoneal lymphadenectomy'.
Why do I need to have this RPLND surgery?
There are several reasons why your doctor may recommend this surgery. Let's take a look at the benefits of this surgery.
| Main reason | Simply put... |
|---|---|
| Determine the stage of the cancer | Removing and examining lymph nodes can help determine exactly how far the cancer has spread in the body. This is called determining the stage of the cancer. |
| Stop the spread of cancer | If cancer cells enter the lymph nodes, they can travel through the lymph vessels to other parts of the body. This is called metastasis. So, removing these lymph nodes can help stop the spread. |
| Reduce the risk of cancer coming back | Removing lymph nodes that contain cancer cells can greatly reduce the risk of cancer recurring in the future. |
| As a treatment if the cancer comes back | Sometimes, if the cancer comes back after treatment, this surgery is done to remove the lymph nodes that contain cancer cells. |
In particular, RPLND is sometimes performed for both staging and treatment of testicular cancer . It is also performed for other types of cancer, such as kidney cancer, some cancers of the female reproductive system, and some types of sarcomas.
How do doctors know if I need an RPLND?
If your imaging tests show that the lymph nodes behind your abdomen are swollen, your doctor may tell you about this surgery. These types of scans include:
- CT scan
- MRI scan
- PET scan
Your doctor may recommend this surgery at another point in your cancer treatment journey. Your doctor is the best person to explain why you need this surgery. He or she knows your situation best. So don't hesitate to ask him or her any questions you may have.
How is this RPLND surgery performed?
Before the surgery begins, you will be fully anesthetized. This means you will be completely asleep. So you will not feel any pain.
The surgeon then makes an incision in your abdomen and carefully removes the lymph nodes closest to the cancer.
The main goal of this surgery is to remove all lymph nodes that may contain cancer cells and completely stop the spread of the cancer. To achieve this goal, sometimes other things may need to be removed in addition to the lymph nodes.
- Several other lymph nodes from another part of the body.
- Another organ, like a kidney.
- Other tumors or tissues in that area.
Nowadays, some hospitals perform this surgery as laparoscopic surgery, which is done through a few small incisions, or using robotic surgery. Your doctor will explain which method is right for you.
This RPLND surgery can take anywhere from three to ten hours .
What to expect after surgery?
You will need to stay in the hospital for about four to seven days after the surgery. It is normal to have some pain after the surgery. Your doctor will give you the necessary painkillers for that. So don't worry about the pain.
What are the risks of this surgery?
Like any major surgery, RPLND surgery has some risks. Your doctor will explain all of these to you in advance.
| Risk | Description |
|---|---|
| Damage to blood vessels | The doctor is performing the surgery very close to the body's major blood vessels. Therefore, in rare cases, these blood vessels may be damaged and additional bleeding may occur. |
| Affecting fertility | Ejaculation problems can occur after surgery. This is because the nerves that control ejaculation run through the area where the surgery is performed. Most of the time, surgeons protect these nerves from damage. However, sometimes a condition called anejaculation can occur. |
| Lymphatic fluid accumulation (Lymphocele) | Lymph fluid can accumulate in the space left by the lymph nodes being removed. To remove this extra fluid, your doctor may place a small tube (drain) in your abdomen. |
| Other complications | As with any surgery, there is a small risk of infection, breathing difficulties, damage to other organs, lower abdominal pain, and constipation. |
What is in the report after the surgery?
Your doctor will explain to you the pathology report that you receive after examining your lymph nodes.
You can use the words "positive" or "negative" in it.
- A positive result means that there were cancer cells in the lymph nodes that were removed.
- A negative result means that there were no cancer cells.
In addition, the report also states how many of the total number of lymph nodes removed contained cancer cells. Also,
- Type of cancer.
- How different the cancer cells are from normal cells (grade).
- The rate at which cancer cells divide (mitotic rate).
The report may contain other important information, such as:
What happens next after the results are received?
Based on the results of your report, your medical team will decide what to do next. It may be something like this:
- Observation / surveillance without any treatment
- Chemotherapy
- Radiation therapy
What time should I call the doctor?
Once you get home, you need to take great care of your recovery. Be especially careful about how your surgical wound heals. If you have any of the following symptoms, call your doctor right away.
| Warning signs - notify doctor immediately | |
|---|---|
| Nausea or vomiting | If you are vomiting so much that you cannot keep even a little water in your stomach. |
| Lower abdominal pain | If you feel tightness, severe pain, or pain when you touch your lower abdomen. |
| No flatulence or bowel movements | If you are unable to pass air or defecate. |
| Pus draining from the wound | If there is pus-like fluid coming out of the surgical incision. |
| Severe pain | If you have severe pain that cannot be controlled even with painkillers. |
Any surgery is scary, especially when it involves cancer. But remember, RPLND is a life-saving procedure that gives doctors vital information about your health and can stop the spread of cancer.
If you still have doubts or fears about undergoing such a major surgery, there is nothing wrong with seeking a second opinion from another specialist. Perhaps talking to another doctor will give you a lot of peace of mind and give you the mental strength you need to face the surgery.
This surgery is a big step in your life. But it could save your life. Your medical team is here to help you. So talk to them about any questions or fears you have.
Take-Home Message
- RPLND is a major surgery that removes the lymph nodes behind the abdominal organs.
- This is mainly done to see if the cancer has spread, stop it from spreading, and prevent the cancer from coming back.
- As with any surgery, there are risks, such as bleeding and effects on fertility. Your doctor will inform you about these.
- It takes time to recover after surgery. It is very important to be aware of signs of infection (fever, pus from the wound, severe pain).
- Be open about your fears and concerns with your medical team. Never hesitate to get a second opinion if necessary.
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