Retroperitoneal lymphadenectomy
What is it?
Retroperitoneal lymphadenectomy is a surgical procedure necessary in some forms of testicular cancer and consists in the removal of lymph nodes located along the large blood vessels at the level of the posterior wall of the abdominal cavity.
When is this procedure indicated?
As part of the multimodal treatment of testicular cancer, and according to the indications of the international guidelines, this surgery is mainly indicated in the treatment of residual masses after chemotherapy, especially in non-seminomatous tumors. The exception is primary lymphadenectomies indicated in cases of high risk stage I non-seminomatous tumors or in marker negative stage IIA tumors.
How is it performed?
Retroperitoneal lymphadenectomy involves the removal of lymph nodes in the retroperitoneum (space corresponding to the posterior wall of the abdominal cavity) that are located in close proximity to the large vessels (aorta and vena cava). Lymphadenectomy is performed in patients with testicular cancer because for embryological reasons the lymph nodes of the retroperitoneum represent the first site of spread of tumors starting from the testicle.
Lymphadenectomy can therefore be "modified", i.e. limited depending on the laterality of the tumor, and "nerve-sparing", i.e. it can provide for the sparing of nerve fibers (reported anterograde ejaculation rates of 90-100%). The "nerve-sparing" technique is suitable for patients with stage I or II non-seminomatous cancer (spread to the retroperitoneal lymph nodes) with low lymph node involvement and in selected cases of post-chemotherapy treatment. Retroperitoneal lymphadenectomy can be performed by open, laparoscopic, or robotic-assisted technique. It is a major surgery to be performed in highly specialized reference centers.
Recovery
Post-operative hospital stay is on average about 4 days for retroperitoneal lymphadenectomy surgery. Hospital stay may be longer after chemotherapy treatment or in case of surgery extended to other organs.
Short-term complications
Possible short-term complications are lymphoceles (collections of lymphatic fluid in the abdominal cavity) and chylous ascites, both due to the transient interruption of lymphatic drainage.
Long-term complications
The main potential long-term morbidity related to retroperitoneal lymphadenectomy is loss of ejaculation (discharge of seminal fluid from the urethra at orgasm). This condition can occur if there is damage to the sympathetic nerve fibers that run around the retroperitoneal lymph nodes themselves.
The incidence of this complication is related to the necessary extent of lymphadenectomy dictated by the stage of the disease.
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