RPLND

RPLND, short for retroperitoneal lymph node dissection, is a surgical procedure used primarily in the management of testicular germ cell tumors. The operation involves removal of lymph nodes in the retroperitoneal space, which is the area behind the abdominal lining, to remove cancerous tissue, improve staging information, and guide further therapy.

Indications for RPLND typically include non-seminomatous germ cell tumors of the testis, often after orchiectomy in selected stage I or II disease. It may also be used to treat selected patients with limited retroperitoneal metastases or to remove residual masses after chemotherapy in certain circumstances. The goal is to achieve local control of disease and to provide pathologic information that helps determine subsequent treatment.

The procedure can be performed as an open surgery or using minimally invasive approaches, including laparoscopic or robotic-assisted techniques. An experienced surgical team performs an en bloc dissection of lymphatic tissue from regions around the aorta and vena cava down to the iliac vessels. Nerve-sparing techniques may be employed to preserve ejaculation in men, when feasible. Perioperative planning considers the extent of disease, potential complications, and the patient’s anatomy.

Common complications include lymphocele, chyle leak, vascular or nerve injury, infection, ileus, and deep vein thrombosis. Ejaculatory dysfunction can occur if sympathetic nerves are damaged, though nerve-sparing approaches reduce this risk. Recovery typically requires several weeks, with hospital stays varying by approach and patient comorbidity.

Prognosis depends on disease stage, tumor histology, and response to additional therapies such as chemotherapy. RPLND can be curative in select localized cases and provides important staging information that influences subsequent treatment decisions.