Short-term morbidity of primary RLND in a contemporary group of patients.

[Jay68442]

I had my RPLND done in 1989 at the age of 17. I guess there being no internet was good in a sense. You can go online and google anything and find contradicting reports. And when it comes to cancer or any illness for that matter one can literally dive themselves crazy by ready all that is available. Is a traditional RPLND better? I have no idea. But I do know in my case it worked. The surgery was long and my stay in the hospital was about 10 days. As far as long term effects, well I guess I am still here .
I do have 3 distinct memories from my RPLND.

First. While being transported back to my room after recovery the orderly put the bed I was wheeled up on to close to my bed and started lowering it. Because it as up against my bed the one I was on was not going down. Well that was until they moved the one I was on and it dropped almost a foot. Oh the pain. Fresh out of surgery and not on pain meds yet.

Second. During the operation they placed an IV in my leg. When I was coming around in the recovery room. Still going in and out of consciousness all I could think about was this pain in my leg. I was thinking to myself why in the world does my leg hurt, I didn't have surgery on my leg. When I was finally awake enough I pulled off the blanket to look and saw the IV. I called the nurse over and said get this damn thing out of my leg.

Third. Oh this is a good one. As many of us know from having a RPLND you wake with a catheter. So when you are getting close to being able to leave the hospital they remove it and you hope that you will be able to go on your own. But in some cases the plumbing doesn't always work so well after. During the course of the day I try to go. Try and try again. Nothing. Still getting plenty of fluids though. As the day goes on I am told if I can't go soon they will have to put the catheter back in. Still trying, sink running and everything I can think of, you guessed it nothing. So its time to put the catheter back in. The doctor that is doing it doesn't attach the other end of the hose to the bag. You see it coming. Yup urine all over the place. All over me and my bed. Like having someone hold your penis and stick a tube in it isn't bad enough.

I don't mean to worry anyone about to go through this. Maybe you just learned something. If they have to put the catheter back in make sure the other end is attached.

If you ask me if I would do it again the answer is Yes. I would do anything to live.

[H2o]

Maybe my stay was longer because I was an older fellow?

I was only 25 when my RPLND took place Sept of 1980. I believe a TC diagnosis 10yrs earlier then mine was usually a death sentence. Dr Sogani took great care of me & was one of the most caring Dr's Ive ever met. Surgery took 6hrs & a 21 day hospital stay followed at Sloan Kettering. I was doing well recuperating there until one day I felt like the life drained out of me while walking the floor w/my IV stand. Recieved 2 blood transfusions & felt well enough to go home a week after receiving them. The average stay I was told back then was about 10 to 14 days. I've always been amazed at how short the stays have been since I had my surgery. Guess the RPLND has been refined with time. Having retrograde ejaculation as a result of my surgery has bothered me from time to time. They said there be no difference except it'd be dry but for me the feeling was very different & much less intense. Let alone being left sterile as a young man. I was glad to hear nerve sparing surgery was being done & wished it had been available then. But if it had been an option for me who knows if they'd have gotten it all with the L-RPLND from what I've read. Now at 52 it all really doesn't matter that much. I survived & lived to see my nieces & nephews be born & grow into teenagers & young adults. It's been the biggest gift of my life. I'm thankful!!
I wish the best to all who are facing or going through this now.

[Flyman]

laparoscopic retroperitoneal lymph node dissection

I'm a very new member to this great TC Forum but from what I've read many surgeons have expressed unfavorable opinions about the laparoscopic retroperitoneal lymph node dissection. If you google it I'm sure you will locate sites that discuss it thoroughly and most of the sites I found preferred the traditional RPLND over this newer procedure.

Speaking from first hand knowledge I had a traditional RPLND performed in February of 1994. It was a long surgery and my wife tells me I was in the operating room for almost eight hours. I was fifty years old when it was perfomed and while it was tough I made a full recovery.

I'm assuming there may have been some changes in the procedure since I had it performed in 1994 because I was in ICU for three days and in the general surgical recuperative area for another ten (10) days! I see many postings at this Forum and other sites where six to eight days is the longest stay and many are much shorter. Maybe my stay was longer because I was an older fellow?

[RTC]

oh . . . yeah I guess so . . . sometimes I have been thinking.
The idea of open RPLND is so scary maybe I should run away from it
and do L-RPLND . . probably a very very stupid idea.

It is interesting though that I read quite a bit of different technique being
explored in Europe . . .

One use "water pressure" like 20 bar or something to remove the nodes
when doing L-RPLND.

One called "hand assisted L-RPLND" . . . they have another incision to allow surgeon's hand into the abdominal . .

It sounds so strange . .

It is encouraging though to see that contemporary group of patient getting open RPLND have less complication and just have about better at everything .

However I think just 1 day after the operation to start clear liquid diet is a bit too soon??? Most members at this forum warned again and again not to drink or eat anything too soon?

And few Nasogastric tubes were placed?????

I actually read an article not long ago . . saying that some practice in medicine such as placing the NG tube is done because "that is the way it has been" without real evident of the benefit . . . . maybe that is the case so
Indiana University hospital no long put NG tube in every patient?

As for shortened hospital stay . . . . my thinking is . .
"gee . . . don't discharge me so soon . . . let me have that morphine pump for a few more days . . haha "

[Margaret]

It may be an unpopular opinion but I am not a big fan of laparoscopic retroperitoneal lymph node dissection. After speaking at length with Dr. Sheinfeld at SK, and why he finds the surgery risky and showing long term problems, I was set straight.

When we started our quest to find an RPLND doc (of course we did not know about this wonderful forum) it took us to many places. We found a few doctors that were willing to do the procedure laparoscopic...but after finding Dr. S we changed our minds and it was scary how close we came to selecting the lapro. option. Dr. S had treated men that have gotten this surgery done lapro and they leave tiny amounts of tissue and cancer behind. And when the cancer returned, it was more agressive.

The up sides to the shorter hospital stay and ability to consume food/drink more quickly is a nice selling feature of the operation. But for my money I just want it done right the first time. I am SURE there are people that have had the Laparoscopic RPLND done and had GREAT results. But for me, I want there to be more experience with it before I would select this for my family member. I guess you could say that Dr. Sheinfeld was very convincing.

[RTC]

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17561131&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Mean operative time was 132 minutes (range 81 to 246) and mean blood loss was 207 cc (range 50 to 500). Nasogastric tubes were placed in 2 patients (2.7%). Mean hospital stay was 2.8 days (range 2 to 4).

wow . . . seems pretty amazing that for such a big procedure to get those numbers .. .

Mean time to start clear liquids was 1.0 day. sounds so good to be true