Retroperitoneal Lymph Node Dissection

After you come out of theatre, staff will transfer you to the recovery area in theatre for an hour or two until you are moved to the ward. Occasionally, the initial postoperative period will be in the Intensive Care Unit.

To reduce the pain in your abdomen after the operation ward staff will give you pain killers. The anaesthetist will discuss the options with you: a pain killer device that you control, that releases pain killers into your blood stream via a drip (Patient Controlled Analgesia), or an epidural by which pain killers and local anaesthetic given directly into the spinal nerve system. This involves inserting a very fine plastic tube into your back through which these drugs are given.

After about two days the need for these types of pain killers is greatly reduced, and you will be able to have the systems removed. The ward staff will then give you pain killing tablets or injections instead. Please tell the staff looking after you if you are still in pain or discomfort as it may be that your medication needs to be altered.

You will have a central line running into a vein in your neck to give you fluids and occasionally nutrition until you are able to drink normally (about 3 to 4 days after the operation). When you are able to drink you will then be allowed to start to eat again (about 4 to 6 days after surgery).

After the operation the physiotherapists will visit you to teach you deep breathing and leg exercises. It is important that you carry out these exercises regularly as they will help to prevent a chest infection and blood clots in the legs that can occur whilst you are not as mobile as you would be normally.

If your operation has involved a cut that goes into your chest, the surgeon may need to put a drain into the side of your chest during the operation. This drain allows the lung, which would collapse during the surgery, to re-inflate. The drain normally stays in place for up to 3 days. A chest x-ray will be carried out to make sure that the lung has re-inflated before the drain is removed.

As well as a dressing on your wound, you will also have a drain (a small plastic tube) from your abdomen which drains away fluid from inside your wound. This will normally stay in place for 4-5
days.

The amount of fluids that you can drink immediately after the operation will be restricted. This is to prevent you from being sick. You will gradually be able to drink and eat normally – usually be about 4 days after the operation.

General risks of surgery include:

• Bleeding at the operation site.
• Infection in the wound or chest.
• Heart irregularities due to the anaesthetic and surgery.
• Blood clots in the legs (DVT) or lungs (PE).
• Removing the lymph nodes from the abdomen can cause infertility in some men because of an effect called retrograde ejaculation. Retrograde ejaculation means that during sexual intercourse when you ejaculate or have an orgasm, the fluid (semen) that usually comes out of your penis goes backwards into your bladder instead. The semen is then passed out harmlessly the next time you pass urine. But it means that it is highly unlikely you would be able to father children without having some medical help including storing sperm before you have the operation.
• It can be possible in this operation for the surgeon to lessen the risk of damaging the nerves bycertain types of node removal. However, it is not always possible to do this after chemotherapy as the lymph nodes may be close to the nerve pathways. In some cases trying to preserve the nerves would increase the chances of leaving behind some of the lymph nodes. This would increase the possibility of the cancer coming back.
• The affected lymph glands are usually very adherent to the major blood vessels in the abdomen. Also the blood vessels near to a kidney may also be closely involved with the lymph glands. If this is the case then there is a risk to the blood vessels and kidney and on rare occasions it may be necessary to repair or replace the major blood vessels with an artificial graft. Rarely, it may be necessary to remove a kidney. Similarly other major organs such as the bowel, pancreas and spleen may be injured requiring repair or removal.
• Division of the lymph vessels as part of the surgery may occasionally cause a leakage and buildup of lymph fluid within the abdomen. This may delay your discharge from hospital and occasionally require the reinsertion of a drain or re-operation. A special diet is usually necessary to prevent this and you will be advised about this.

Most patients stay in hospital for between 7 and 10 days after this operation. By the time you are ready to go home you will be looking after yourself without the need for help from others. However, you will feel tired when you get home and it is important that you rest as well as take gentle exercise such as walking. For a few weeks after surgery you will appreciate some time to recuperate and gradually get back to normal. This may take between 6 and 12 weeks. We will give you a letter to take for the district nurses and necessary tablets, such as painkillers to take home.

Getting back to work depends on the type of work that you do. You will probably need about 6 weeks off work. If your job involves manual work such as lifting then you will need about 12 weeks off work. If you are unsure about it ask the team looking after you. You can get a sick note for the time that you are in hospital from the ward staff. Your GP or specialist can give a sick leave for the rest of the time you need to have off.

Lifting

Be careful about what you lift such as sport and carrier bags and small children! For the first 6 weeks, try not to lift anything.

Driving

Until you can safely carry out an emergency stop without it causing pain you should not attempt to drive. This will take about 4-6 weeks.

Follow up

We will give you an appointment to to see the surgeon about 4 weeks after the operation. At this appointment we will be able to give you the results of the findings from the laboratory of the specimen of lymph nodes that were removed at the time of your operation. Further follow up will be under the care of the team that gave you your chemotherapy.