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Retroperitoneal Lymph Node Dissection

bitas
Posts: 3
Joined: Jun 2010

My 28 yr old husband is scheduled for this surgery this monday 06/28/2010. He had 1 testicle removed already. Went thru 4 cycles of BEC all his tumor marker levels were under normal range after all chemo was finished. His ca had spread from testicular to abdomen and chest. When he went to a ct scan after his chemo was done they still see a tumor. ( He had/has 4 typs of cancer) Chemo doesn't kill all of it so now he needs to have this massive surgery. We are scared to death what happens if it is still cancer we are hoping its scare tissue. The surgery will take 8 hrs he will be in the hospital for 5-6 days and have an epidural in his back for 2-5 days, depending on how fast he recupes from the surgery. Does anyone have any knowledge of this surgery. How is the recovery what happens if they find more cancer. Please keep my husband in prayer we are all very scared over this frightening situation.

Thank you

HeartofSoul's picture
HeartofSoul
Posts: 732
Joined: Dec 2009

First thing i would do is get a second opinion from another medical oncologist (a different office) as its common practice to get more than once viewpoint on treatment.

Do you know the type of testicular cancer your spouse has as there are different types. Also what stage was his cancer? Types of testicular cancer are non-seminoma, seminoma, mixed.

The nonseminomas include: choriocarcinoma (<1%), embryonal carcinoma (24%), teratoma (30%), and yolk sac tumors (<1%). The peak occurrence for nonseminomas is between ages 20 and 30. Most testicular tumors contain a mixture of both cell types and are called mixed germ-cell tumors. If a tumor contains any proportion of non-seminomatous tissue, it is classified as a nonseminoma. If the tumor contains only seminoma cells, it is called a pure seminoma. The two types behave differently and have different prognoses and treatments, so distinguishing between seminoma and nonseminoma is critical to appropriate treatment.

Do you know the size of the tumor and where its located which was revealed by the cat scan after chemo treatment? There is a chance that the tumor (growth) may not be malignant as the chemo, (especially cisplatin) could have left residue/inflammation that appears on catscan. When you said BEC , did you mean BEP (which is chemo meds bleomycine, cisplatin and etoposide)? If it is, 3 rds is standard protocol.

The chemo may kill the cancer, but one of the things left behind, teratoma, must be removed. Teratoma is a benign tumor with a tendency to grow or degenerate back into another cancer. If the stuff left after chemo is large enough (perhaps more than 1-2cm), it is likely that the doctors will want to remove it. In a few cases it is possible that the chemo did not completely kill all the cancer. In these cases, removing the lymph nodes might also be therapeutic and cure the cancer.

Make no mistake, we're talking major surgery here. In a nut shell, the RPLND involves an incision from just below your sternum to below the belly button (but they do go around it!). Your intestines and associated organs are literally lifted out of the way, nerves are identified and hopefully moved out of the way, and then the surgeons remove all the lymph nodes that were connected to the testicle containing the tumor.

The operation itself can take 3-6 hours, but I have spoken with doctors who have had advanced cases lasting 10+ hours! They usually check the lymph nodes on the same side as the affected testicle first, and if they find anything suspicious, they may check the other side as well for additional spreading.

This is a very well studied surgical procedure: if you come out clean, odds are pretty good that you are TC free! (not good enough to never go back to the doctor, but very good nonetheless.) If they find cancer, you've most likely got a longer (but still survivable!) path of surveillance or chemo in your future.

Is this surgery "risk free"? Absolutely not! It is a complicated and delicate procedure that is rarely done. There are far more urologists in the US than there are RPLND's in a single year. Few doctors do more than a couple of these surgeries a year. This is one time when you should be willing to hurt your urologist's feelings and look for someone who has some experience. If you need a post-chemo RPLND, I strongly suggest that you find someone who has done the procedure many times before. (I also suggest banking sperm before the surgery if you are interested in having children in the future. It is good insurance and worth the expense.)

Laparoscopy is a surgical procedure in which a tiny scope is inserted into the abdomen through a small incision. Its use in testicular cancer is experimental and controversial.

bitas
Posts: 3
Joined: Jun 2010

Thank you so much for responding I know there are millions of people with cancer but it just feels like you are alone and it is so scary no matter what the drs say they are saying it from a professional stand point not as a patient

Once again thanks

Davepet's picture
Davepet
Posts: 92
Joined: Dec 2009

Yes, I've had a RPLND, but it was 35 years ago & the procedure seems to have improved since then. My experience was ugly & I won't detail it for you cause your's will likely be better. Still,it won't be fun, but he'll recover & be fine, just be aware it will take a while & at times it might seem like things will never get back to normal. They will, eventually.

Dave

bitas
Posts: 3
Joined: Jun 2010

Thank you so much for responding I know there are millions of people with cancer but it just feels like you are alone and it is so scary no matter what the drs say they are saying it from a professional stand point not as a patient

Once again thanks

tkrumroy's picture
tkrumroy
Posts: 9
Joined: Aug 2010

I had this surgery in April of 2009 by a surgeon out of Sloan Kettering in NYC. He is an extraordinary doctor/surgeon, but I did have some complications.

If you guys decide to do this, or already have, and have some questions please feel free to message me.

Good luck guys!

annamc
Posts: 1
Joined: Aug 2010

My boyfriend has just been told that he will probably need this procedure (he had testicular cancer last year, had chemo and was given the all clear in July, a month before I met him. Recent scans have revealed the lymph node in his tummy is now around 2cm in diameter)he gets his blood work back tomorrow to see whether there are any tumor markers in them. He's obviously very worried about a number of things regarding this, nerve damage, scarring and any subsequent chemo he might have to have afterwards, so any advice or experience of this conveyed would be much appreciated. We are in the UK, so the heath care system is different to the US. I want to be as much support to him as possible while he goes through this (He was on his own last year, and I don't want him to have to go through that loneliness again!), so any advice on how I can do this would also be greatly appreciated.

Thanks so much in advance.

Davepet's picture
Davepet
Posts: 92
Joined: Dec 2009

What type of TC did he have & what stage was his original diagnosis?

Try to find a surgeon that has lots of experience with RPLND to have the best chance of sparing nerves.

Scarring is something we just have to learn to live with after this surgery. I never worried much about my scar, most folks either don't notice or are too embarrassed to ask about it. Either is fine w/ me.Those that ask get an answer that gives little info, unless they are close. "I had cancer" is all most folks need to hear. Once or twice I said "I was in a knife fight" just to get a reaction ;o)

Subsequent chemo will depend on what the path reports from the RPLND say. There's a good chance this won't be needed, but it certainly isn't impossible, either.

You & he are just going to have to learn to go with the flow as each step is taken towards what will likely be a final cure.Each test & each treatment defines what happens next, so you gotta be flexible & bend with the punches. It's really the only choice you have...
Dave

lemoniqu
Posts: 1
Joined: Feb 2011

Have RPLND sugery or Not?

My fiance just finished his chemotherapy and after reviewing the CT scan the doctors gave him the option of chosing whether or not to do RPLND surgery. The CT scan came back clean, they found nothing!! And we have no idea whether to do the surgery or not. If the surgery did not have so many risks involved we would easily do it, but we are second guessing ourselves. He too is getting treated at Sloan Kettering in NYC. Who was your doctor? We have until the 10th to decide and we are going crazy not knowing what the best choice is.

I would greatly appreciate hearing your story and experience at Sloan and the surgery.

Thank you,
Monique

Davepet's picture
Davepet
Posts: 92
Joined: Dec 2009

I assume I am too late & you already had the surgery? Hope it all went well?

Dave

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