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RPLND: what the operation involves | CION Cancer Clinics
Retroperitoneal lymph node dissection, or RPLND, removes the lymph nodes at the back of the abdomen, around the main blood vessels, where testicular cancer spreads first. It is a major operation under general anaesthetic, done either after chemotherapy to remove a leftover lump, or instead of it for a small amount of early spread. This page explains what is removed, what happens on the day, and how recovery usually goes. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What does an RPLND operation actually involve?
- What the surgeon is removing, and what they are protecting
- What happens from the anaesthetic to the ward
- Words you will see on the consent form and the report
- How recovery usually unfolds
- Three things families tell us about RPLND, and what is true
- Who it does not suit, and what this page cannot tell you
- Common questions about RPLND surgery
The short answer
What does an RPLND operation actually involve?
RPLND is an operation to remove the lymph nodes (small glands that filter fluid from the tissues) that sit at the back of the abdomen, in front of the spine and around the main blood vessels. It is done for testicular cancer, because those are the nodes the cancer reaches first. The surgeon opens the abdomen, moves the bowel aside, and clears the nodes from a mapped area on either side of the aorta.
Why the nodes are so deep
The testicles begin life near the kidneys, before birth, and travel down into the scrotum. Their lymph channels keep that long route. So when testicular cancer spreads, it goes up to the nodes beside the kidneys, not to the groin. That is why this is an abdominal operation.
When it is offered
Most often it is offered after chemotherapy, when a scan shows a lump of tissue still sitting where the nodes were. Less often it is offered instead of chemotherapy, for a small amount of early spread. Your team will tell you which applies to you.
The testicle itself is removed in a separate, much smaller operation through the groin, usually well before RPLND is discussed.Inside the operation
What the surgeon is removing, and what they are protecting
The lymph nodes
They run in chains along the aorta and the vena cava, the two largest blood vessels in the body. The surgeon lifts the fatty tissue holding the nodes off these vessels, from the kidney veins down to where the vessels split towards the legs.
The residual mass
After chemotherapy the nodes are often fused into one firm lump, stuck to the vessels. It is taken out in one piece wherever possible and sent to the laboratory. That report shapes what happens next.
The nerves for ejaculation
Fine nerves cross this area on their way to the bladder neck. If they are cut, semen flows backwards into the bladder instead of out. Where the anatomy allows, the surgeon finds and protects them.
Ask your surgeon whether nerve-sparing is planned for you, and if not, why.The organs alongside
The kidneys, the ureters (the tubes from kidney to bladder), the bowel and, on the left, the spleen and pancreas all border the field. They are moved aside, not removed. Rarely a mass is stuck to one of them and part of that organ has to come out too.
Not sure whether this applies to you?
Ask an oncologistOn the day
What happens from the anaesthetic to the ward
Going to sleep
A general anaesthetic, so you are fully asleep. Often a fine tube is placed in the back first, for pain relief that lasts several days. A catheter drains the bladder and a line in the neck or arm gives fluids.
The cut
In the open operation, a single cut runs from below the breastbone to below the navel. Keyhole and robotic versions use several small cuts. Ask your centre which approach they use and why.
Reaching the nodes
The bowel is lifted and moved to one side. The surgeon then works along the aorta and vena cava, freeing the tissue that holds the nodes and tying off small vessels as they go.
Closing
The bowel is laid back in place and the wound is closed in layers. Sometimes a drain is left in. Most people then wake in an intensive care or high-dependency bed for the first night.
On your notes
Words you will see on the consent form and the report
- Retroperitoneum
- The space at the back of the abdomen, behind the bowel and in front of the spine. It holds the kidneys, the great vessels and these nodes.
- Template
- The mapped area of nodes the surgeon plans to clear. A full template covers both sides; a modified template covers a smaller area on the side of the original cancer.
- Nerve-sparing
- Finding and protecting the nerves that control ejaculation during the dissection. Not always possible, especially around a large mass.
- Residual mass
- Tissue still visible on the scan after chemotherapy. It may be scar, a slow-growing tumour type called teratoma, or living cancer. Only the laboratory can tell which.
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Afterwards
How recovery usually unfolds
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The first day or two
You are helped to sit up and stand early, even though it feels too soon. Sips of water first, then food as the bowel wakes. The catheter and any lines come out over these days.
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The rest of the hospital stay
Walking the corridor a few times a day, breathing exercises, and a slow return to normal meals. Most people go home in about a week.
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The first weeks at home
Tiredness is the main complaint. No lifting anything heavier than a filled water jug, no driving until you can brake hard without pain, and short walks that get longer each day.
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The report appointment
The laboratory report on the removed tissue usually takes a week or two. It decides whether any further treatment is needed, so bring the family member who helps you make decisions.
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Back to normal life
Desk work is often possible within a few weeks. Heavy physical work, cricket and gym training wait longer, until the abdominal wall has healed and your surgeon has cleared you.
Commonly believed
Three things families tell us about RPLND, and what is true
"If the testicle is already out, why open the abdomen?"
Because the testicle is not where the cancer goes next. The nodes at the back of the abdomen are, and removing the testicle does nothing about them. RPLND is done for those nodes, not for the testicle.
"The lump on the scan means the chemotherapy failed."
Often it does not. A lump left after chemotherapy is frequently dead scar tissue or a slow type of tumour that chemotherapy does not shrink. The operation removes it and the laboratory tells you which it was.
"He will not be able to have children afterwards."
The operation does not touch the remaining testicle, so sperm are still made. What can change is the direction semen travels. Nerve-sparing lowers that risk, and sperm banking before surgery keeps the option open whatever happens.
Being straight with you
Who it does not suit, and what this page cannot tell you
RPLND is not the right step for everyone with testicular cancer. Many men with early disease never need it, because surveillance or chemotherapy does the job. Men whose tumour markers are still rising after chemotherapy are usually offered more drug treatment first. And a person too unwell for a long anaesthetic may be advised against it.
Whether you should have it
This page cannot tell you that. The decision rests on your scan, your blood markers, the type of tumour you had and your general fitness, read together by a team that has seen all of it. What you can do is ask them three things: what they expect to find, what happens if nothing is done, and what changes if the report shows living cancer.
How you will feel afterwards
Nobody can promise that either. Most men return to normal life. Some have lasting changes to ejaculation, and a few have complications that lengthen recovery. Ask your surgeon for the risks that apply to your case, not a general list.
If you have a report and do not know what it means, call the helpline. Someone will read it with you.Questions we are asked
Common questions about RPLND surgery
How long does the RPLND operation take?
Usually several hours, so the family should expect a long wait. The time depends on how much tissue has to be cleared and whether a mass is stuck to the blood vessels. A longer operation does not mean something has gone wrong. Ask the ward for a rough time before you start to worry.
How big is the scar?
For an open operation, one straight scar down the middle of the abdomen, from near the breastbone to below the navel. It fades but does not disappear. Keyhole and robotic operations leave several small scars instead. Which you have depends on your scan and on what your centre offers.
Will I be in the ICU?
Usually for the first night, sometimes two. This is planned, not a sign of trouble. It lets the team watch fluid balance, pain control and the wound closely while the anaesthetic wears off. You then move to a normal ward.
How much pain should I expect?
The first few days are the hardest, and the pain is controlled with a tube in the back or a pump you press yourself. Most people are on tablets by the time they go home. Coughing and getting out of bed hurt most, so you will be shown how to brace the wound with a pillow.
Should I bank sperm before the operation?
Discuss it with your team before the date is fixed. The operation can change the direction of ejaculation, and if you have had chemotherapy, sperm counts may already be low. Banking is quick, and it keeps the choice in your hands whatever happens in surgery.
Will I need chemotherapy after RPLND?
That depends on what the laboratory finds in the removed tissue. Scar or teratoma usually means no further treatment beyond follow-up scans. Living cancer cells may mean more chemotherapy. Your team will explain the report, and it is reasonable to ask for a copy.
Can it be done by keyhole or robot?
For some cases, yes, especially smaller amounts of disease before chemotherapy. Large masses after chemotherapy are more often done open. Not every centre offers every approach, so ask yours what they recommend for you and why, rather than assuming the newer method is the right one.
Is RPLND covered by Aarogyasri or insurance?
Cancer surgery is generally covered under Aarogyasri, CGHS, ECHS and EHS, and by most cashless insurers, when it is part of an approved treatment plan. Approval takes time, so start the paperwork early. Call the helpline with your card details and we will check your cover.
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Sources
- Cancer Research UK — Testicular cancer: treatment
- National Cancer Institute — Testicular Cancer Treatment (PDQ) - Patient Version
- American Cancer Society — Surgery for Testicular Cancer
- 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
Why testicular cancer spreads to the back of the abdomenWhy the nodes are where they arePrimary vs post-chemotherapy RPLNDWhich of the two situations applies to youNerve-sparing RPLND and ejaculationThe question most men are afraid to askRecovery after RPLNDWeek by week, from the ward to workICU and the first days after surgeryWhat the first night looks like for the family
Talk to us
Been told you may need RPLND?
Send us the scan report and the pathology report, or call the helpline. A surgical oncologist will read them with you and explain what the team is likely to weigh. One helpline serves every CION centre.