Retroperitoneal Lymph Node Dissection (RPLND)
Surgical Removal of Retroperitoneal Lymph Nodes for Testicular Cancer
What is Retroperitoneal Lymph Node Dissection (RPLND)?
RPLND is the surgical removal of the retroperitoneal lymph nodes — the primary landing zone for testicular cancer metastasis — through a midline abdominal incision. It is indicated for clinical Stage II NSGCT, residual retroperitoneal masses after chemotherapy (post-chemo RPLND), and selected Stage I high-risk NSGCT. RPLND provides accurate staging, removes potentially viable or malignant residual disease, and is curative for lymph node-confined disease. The procedure is performed under general or spinal anaesthesia with a hospital stay of 4–7 Days. Success rates reach >95% cure in appropriately selected patients at experienced centres.
How the Procedure Works
Incision & Exposure
A midline incision from xiphisternum to pubis provides access to the entire retroperitoneum.
Template Dissection
The retroperitoneal template is dissected systematically from the renal vessels superiorly to the iliac bifurcation inferiorly.
Nerve Identification & Preservation
The postganglionic sympathetic fibres controlling ejaculation are identified descending from L1–L4 paravertebral ganglia and preserved.
Post-Chemotherapy Dissection
PC-RPLND is technically more demanding due to fibrosis and vascular adherence from chemotherapy response.
Drain & Closure
The retroperitoneum is irrigated and haemostasis confirmed. A closed suction drain is placed in the retroperitoneum; wound closed.
Outcomes
Who Needs This Treatment?
- →Men with clinical stage II non-seminoma with retroperitoneal lymph node involvement.
- →Those with residual retroperitoneal masses after cisplatin-based chemotherapy for testicular GCT.
- →Patients with growing teratoma syndrome — enlarging retroperitoneal masses despite falling markers.
- →Men with late relapse non-seminoma where salvage chemotherapy has been completed.
- →Those with stage I non-seminoma who choose RPLND over surveillance or chemotherapy.
- →Patients with retroperitoneal masses from seminoma after chemotherapy where viable disease is suspected.
"RPLND is a technically demanding but life-saving operation for testicular cancer. In experienced hands, it cures lymph node disease with minimal morbidity and preserves the quality of life that young patients deserve."
— — Dr. Vipin Reddy, Consultant Urologist, Andrologist & Renal Transplant Surgeon
Common Questions
Frequently Asked
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