Which surgery for testicular cancer?

Most men have the whole testicle removed in order to diagnose the cancer. This operation is called an orchidectomy or orchiectomy. The testicle can be replaced with a false one, called a prosthesis. This will mean that your scrotum appears normal after your operation. In some men with very small tumours the surgeon removes only part of the testicle (partial orchidectomy) but this is very rare. 

You may have the operation under a general anaesthetic or a spinal anaesthetic (where you are awake but unable to feel anything from the waist down). The surgeon makes a cut in the groin and removes the testicle. The operation normally takes about 30 minutes.

Afterwards you can eat, drink and move around when you have recovered from the anaesthetic. Most people stay in hospital for 1 or 2 days. Your groin and scrotum may be uncomfortable for a week or so and you may need mild painkillers. Most men can go back to normal activities, including work, after 2 weeks. But you may need to avoid heavy lifting and strenuous exercise for a month.

Your ability to have an erection and your fertility will not be affected as long as only one testicle is removed. Having cancer in both testicles is rare. If you do have both testicles removed, you will no longer be able to father children. You will need hormone replacement. There is more about this in the surgery side effects section.

If you still have enlarged lymph nodes in your chest or abdomen after your radiotherapy or chemotherapy, you may have an operation to have them removed. Removal of abdominal lymph nodes is called retroperitoneal lymph node dissection. Removal of lymph nodes in the chest is called para aortic lymph node dissection. These operations are done while you are asleep, under general anaesthetic.

These operations can take up to 4 hours. Beforehand you may need to stop eating and drinking for a few hours and you may have a drip. Afterwards you may be in an intensive care unit (ICU) where your nurses will be able to monitor you closely. You may have a drain from your wound. You may also have a tube going down your nose and into your stomach to drain fluid and stop you feeling sick. 

Your wound will be sore or painful at first but your nurse will give you painkillers. After a couple of days you can usually start to move around. You will be able to go home after about 7 to 10 days. It can take a few weeks for the wound to fully heal. And you need to avoid strenous exercise and heavy lifting for at least 6 weeks.

Removing the lymph glands from the abdomen can cause infertility in some men. It is sometimes possible to do an operation called a nerve sparing lymph node dissection to try to stop this happening. This is a highly specialised operation and may not be available at all treatment centres. It is not always possible to do if there is cancer close to the nerve pathways. Leaving the nerves behind could increase the risk of the cancer coming back. There is more about this in the surgery side effects section.

The National Institute for Health and Clinical Excellence (NICE) has looked at the evidence for using keyhole surgery to remove abdominal lymph nodes after testicular cancer. This is called laparoscopic retroperitoneal lymph node dissection. With this type of operation, the surgeon makes 4 or 5 small cuts (incisions). They put a type of telescope through into the abdomen, called a laparoscope. The laparoscope has an eye piece and hand controls for surgical instruments. The surgeon can see inside the body and carry out the operation while looking down the eye piece of the laparoscope. 

Generally, you recover more quickly after keyhole surgery because you are not having such a big operation. In the studies NICE looked at, hospital stay was around 3 or 4 days after keyhole surgery and about 7 to 10 days after open surgery.

NICE have decided that there is not enough evidence to recommend that keyhole surgery replaces open surgery for removing abdominal lymph nodes after testicular cancer. But it is reasonable for surgeons to carry out this operation if

• They are experienced at doing both keyhole and open surgery to remove retroperitoneal lymph nodes
• Your treatment is either part of a research project, or your surgeon has taken measures to follow your progress (audit)
• There are arrangements in place to make sure all benefits and risks are explained to you before you agree to it

Surgeons have to be experienced because keyhole surgery is very technically demanding. And because they sometimes need to move from keyhole to open surgery during an operation because of complications. In the studies NICE looked at, this happened in between 3 and 10 out of every 100 cases (3 to 10%). The most common complication of keyhole lymph node removal is damage to a blood vessel or the bowel during the operation.

Sometimes specialists will suggest surgery to remove secondary testicular cancer that is growing in the lungs. Your specialist may suggest this because

• There is still a sign of cancer after chemotherapy has finished
• The cancer is thought to be resistant to chemotherapy

Sometimes, if the cancer cannot be cured any other way, surgery is done more than once if the tumours grow back again. This will depend on how fit you are. And it will also depend on how much treatment you want to have.

This is major surgery done under general anaesthetic. Most of the information in the section about having your operation will apply. As well as a drip into your vein and tubes coming out from your wound, you will have a tube into your chest for a few days. This will be connected to a suction bottle. It is there to help your lung inflate again. Surgery to the chest always makes the lung collapse but it can be reinflated over a couple of days. You will have painkillers for some days after the operation. The surgery may involve cutting through a couple of ribs and this can be painful while it heals.