Testicular cancer surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
Surgery
Radical inguinal orchiectomy
Radical inguinal orchiectomy is the first treatment for any stage of testicular cancer and it is usually done as part of diagnosis. In some cases, chemotherapy may be given before this surgery is done.
While you are under general anesthesia (you will be unconscious) or spinal (epidural) anesthesia, the surgeon makes a small cut in the groin. The surgeon removes the testicle and spermatic cord from the scrotum through the opening in the groin. The testicle isn’t removed through the scrotum (called transscrotal orchiectomy) because there is a risk that doing so could spread cancer cells into the lymph vessels. Both testicles may be removed (called bilateral orchiectomy) if doctors believe both testicles have cancer in them. The surgery takes about 30 minutes and you can usually go home the same day.
A testicular prosthesis, or artificial testicle, can be placed in the scrotum after an orchiectomy. The prosthesis may be placed at the same time as surgery to remove the testicle, or it can be placed during another surgery done later. Talk to your healthcare team about getting a testicular prosthesis and the best time to place the prosthesis.
Retroperitoneal lymph node dissection
Retroperitoneal lymph node dissection (RPLND) may be done for stage I and II non-seminomas or for any type of testicular cancer that doesn’t respond to chemotherapy.
While you are under general anesthesia, the surgeon makes a large cut in the middle of the abdomen. The surgeon removes lymph nodes from the back of the abdomen (called the retroperitoneum). If the surgeon removes lymph nodes from the same side of the body as the tumour, it is called ipsilateral RPLND. If the surgeon removes lymph nodes from both sides of the body, it is called bilateral RPLND. The surgery takes several hours to complete.
RPLND may be done at the same time as an orchiectomy, or it can be done later during another surgery.
Salvage surgery
Sometimes testicular cancer doesn’t completely respond to chemotherapy that is given after an orchiectomy. The cancer that remains after these primary treatments is called residual disease. Surgery used to remove residual disease is called salvage surgery. If there are high levels of tumour markers in the blood, some men may have salvage surgery to remove residual disease.
Salvage surgery may include a bilateral RPLND if it wasn’t done during a previous surgery.