Medical Oncologist
CION Cancer Clinics
Retroperitoneal lymph node dissection after orchidectomy | CION Cancer Clinics
RPLND is an operation to remove lymph nodes at the back of the belly, where testicular cancer usually spreads first. It is most often done to remove lumps left after chemotherapy, and sometimes in early non-seminoma instead of other treatment. It is a major operation. This page explains when it is offered, what happens, its risks including effects on ejaculation, and what to ask your surgeon. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What is RPLND after testicular cancer surgery?
- In which situations is RPLND offered?
- What happens before, during and after the operation?
- What are the risks and lasting effects of RPLND?
- What do families often believe about lymph node surgery?
- What do the terms around RPLND mean?
- Common questions about RPLND after testicular cancer surgery
The short answer
What is RPLND after testicular cancer surgery?
RPLND, or retroperitoneal lymph node dissection, is an operation to remove the lymph nodes at the back of the belly, around the main blood vessels. These are the first place testicular cancer usually spreads, so the operation is used to remove cancer there or to check whether any is present.
Why these particular nodes
Lymph nodes are small bean-shaped glands that filter fluid from the body. The testicles develop high inside the belly before birth and then move down. Their lymph channels still drain upwards, to nodes beside the aorta and the large vein next to it, deep behind the bowel. That area is the retroperitoneum.
It is a major operation
An orchidectomy is a small groin operation. RPLND is very different. It is a long operation deep in the belly, done by surgeons with specific experience of it, and recovery takes weeks. It is offered only when the team believes the benefit outweighs that burden.
Not every man needs it
Most men with testicular cancer never have RPLND. Many are treated with surveillance, chemotherapy or radiotherapy instead. This page cannot tell you whether it is right for you. It explains when it is considered and what to ask.
If RPLND has been suggested, ask how many of these operations the surgical team performs each year.When it is considered
In which situations is RPLND offered?
The reason for the operation changes how complex it is and what the surgeon is aiming for.
After chemotherapy, for a lump left behind
The commonest reason. If a scan still shows an enlarged node after chemotherapy for non-seminoma, it may contain dead tissue, teratoma or active cancer. Removing it is the only way to know, and to treat it.
Surgery after chemotherapy is usually harder, because of scarring around the vessels.Instead of chemotherapy, in early disease
In selected non-seminomas, RPLND may be offered as an alternative to surveillance or chemotherapy, both to stage the disease and to remove small spread.
When teratoma is involved
Teratoma does not respond well to chemotherapy, so surgery is the main way to deal with it in the nodes.
Who it usually does not suit
Pure seminoma is rarely treated this way, because it responds well to chemotherapy and radiotherapy. It also may not suit men whose general health makes a long operation too risky.
Not sure whether this applies to you?
Ask an oncologistFrom planning to home
What happens before, during and after the operation?
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Planning and scans
A recent CT scan maps the nodes and vessels. Blood tests include tumour markers. Sperm banking is discussed, because the operation can affect ejaculation.
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Preparing your body
Your fitness, lungs and heart are checked, especially after chemotherapy containing bleomycin, which the anaesthetist needs to know about. Tell the team about every medicine you take.
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The operation
Most often done through a long cut down the middle of the belly. Some centres offer keyhole or robot-assisted approaches for selected cases. Ask your centre which approach it uses and why.
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The first days in hospital
Pain relief, a urine catheter and a gradual return to eating. You will be helped out of bed early to lower the risk of clots and chest infection.
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Recovery at home
Tiredness and a sore wound last for weeks. No heavy lifting until your surgeon clears it. The pathology report on the removed nodes is discussed at your follow-up visit.
Being honest about risk
What are the risks and lasting effects of RPLND?
Like any large abdominal operation, RPLND carries risks of bleeding, infection, clots and a slow return of bowel movement. Some effects are specific to this operation, and it is worth asking about each one.
Changes to ejaculation
The nerves that control ejaculation run through the area being cleared. If they are damaged, semen may not come out at orgasm, although sensation and erections are usually unaffected. Surgeons try to protect these nerves where the cancer allows. Ask your surgeon whether a nerve-sparing approach is possible in your case, and what the chance of this effect is.
Lymph fluid leaks
Occasionally milky lymph fluid collects in the belly after the nodes are removed, causing swelling. It is often managed with changes to diet and sometimes needs drainage.
After chemotherapy, the operation is harder
Scarring can bind the nodes to major blood vessels, the kidney or bowel. Occasionally part of another structure has to be removed or repaired. Your surgeon should explain this before you consent.
This page cannot give you the risk for your own operation. That depends on the reason for surgery, the size of the nodes and your health.Leave a number, we will call you
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After discharge, call the team the same day if
You have a fever or shivering, pain in the belly that keeps getting worse, repeated vomiting or a swollen, tight belly, a wound that leaks pus or opens, pain and swelling in one calf, or sudden breathlessness or chest pain. Sudden breathlessness or chest pain means go to the nearest emergency department now and say you have had major abdominal surgery.
Commonly believed
What do families often believe about lymph node surgery?
"Needing a second operation means the first one failed."
The orchidectomy removes the tumour in the testicle. The lymph nodes are a separate area that the first operation was never meant to reach. A second operation is part of a planned pathway, not a correction.
"If chemo shrank the lump, surgery is pointless."
A lump that remains after chemotherapy can still contain teratoma or active cancer, which a scan cannot tell apart from scar. Removing it is how the team finds out.
"This surgery will end his sex life."
Erections and the feeling of orgasm are usually kept. The main risk is to ejaculation, which affects natural conception. Sperm banking before surgery protects future fertility options.
"Any surgeon who does belly operations can do this."
RPLND is uncommon and technical. It is reasonable to ask how often your surgical team performs it, and whether they work closely with medical oncologists on testicular cancer.
Words you will meet
What do the terms around RPLND mean?
- Retroperitoneum
- The space at the back of the belly, behind the bowel, where the kidneys and main blood vessels lie.
- Post-chemotherapy RPLND
- The operation done after chemotherapy to remove lumps that remain.
- Primary RPLND
- The operation done before any chemotherapy, in selected early cases.
- Nerve-sparing
- A technique that tries to protect the nerves controlling ejaculation.
- Template
- The planned area of nodes to be removed, chosen by the side of the tumour and the scan.
- Dry ejaculation
- Orgasm without semen coming out, one possible effect of nerve damage.
Questions we are asked
Common questions about RPLND after testicular cancer surgery
How long will I be in hospital after RPLND?
Usually several days to about a week after open surgery, sometimes shorter after a keyhole approach and longer if there are complications. You go home once you are eating, walking and your pain is controlled with tablets. Your surgeon will give you a clearer idea for your own operation.
Will I still be able to have children?
If the nerves are preserved and ejaculation is normal, natural conception may still be possible. If ejaculation is affected, fertility treatment using banked sperm or sperm retrieved by a specialist may help. Discuss sperm banking before the operation, while there is still time.
Can RPLND be done by keyhole or robotic surgery?
In selected cases, at centres with experience of it. Not every man is suitable, particularly after chemotherapy when scarring is heavy. Ask your centre which approaches it offers, how often it uses each, and why they suggest one over another for you.
What if the removed nodes show no cancer?
That is common, especially when the lump after chemotherapy turns out to be dead tissue or scar. It still gives useful information and means further treatment may not be needed. Follow-up continues as planned by your team.
What if active cancer or teratoma is found?
Teratoma removed completely often needs no further treatment beyond follow-up. If active cancer is found, your team may discuss further chemotherapy. The pathology report on the nodes guides that discussion, together with your blood tests.
Which medicines should I stop before the operation?
Do not stop anything on your own. Blood thinners such as aspirin, clopidogrel or warfarin, and diabetes medicines, often need a plan. The surgeon, anaesthetist and the doctor who prescribed them will set the timing for you. Bring every strip and bottle to the pre-operation check.
When can I go back to work?
Desk work often returns after some weeks, and physical work later. It depends on the approach, how the recovery goes and what your job involves. Ask your surgeon at the follow-up visit, and plan for tiredness lasting longer than the wound pain.
Is RPLND covered by Aarogyasri or insurance?
Cancer surgery is often covered under Aarogyasri, CGHS, ECHS, EHS and many cashless insurance policies, but the approval rules and limits differ. Call the helpline with your card or policy details and we will check what applies before admission.
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Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
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Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
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Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
Surgical Oncologist
Surgical Oncologist
Dr. Vinay Mamidala
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
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Hematologist
Surgical Oncologist
Dr. Vajja Sandeep Kumar
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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Sources
- Cancer Research UK — Treatment for testicular cancer
- American Cancer Society — Surgery for testicular cancer
- National Cancer Institute — Testicular cancer treatment (PDQ)
- Macmillan Cancer Support — Testicular cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Surveillance, Chemotherapy or Radiation After OrchidectomyWhere RPLND fits among the optionsSperm Banking Before OrchidectomyProtecting fertility before further surgeryComplications and Red FlagsWarning signs after major surgeryICU and the First Days After SurgeryWhat the first days in hospital look like
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Has RPLND been suggested?
Tell us what your scans and reports have shown. We will help you reach a surgical oncologist who can talk through the operation with you. One helpline serves every CION centre.