32503 Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; without chest wall reconstruction(s)

Name of the Procedure:

Resection of Apical Lung Tumor (e.g., Pancoast Tumor) with Chest Wall Resection, Rib(s) Resection, and Neurovascular Dissection, without Chest Wall Reconstruction

Summary

This surgical procedure involves removing a tumor located at the top part of the lung, which often requires excision of parts of the chest wall, ribs, and surrounding nerves and blood vessels. It does not include reconstruction of the chest wall.

Purpose

The procedure aims to treat a Pancoast tumor, a type of lung cancer that affects the apex (top portion) of the lung. The goal is to remove the tumor and prevent its spread, thereby improving survival rates and alleviating symptoms caused by the tumor's pressure on nearby structures.

Indications

• Presence of a Pancoast tumor diagnosed via imaging and biopsy
• Symptoms such as shoulder pain, arm weakness, or Horner's syndrome (drooping eyelid, constricted pupil, lack of sweating on one side of the face)
• Suitable overall health to withstand surgery

Preparation

• Fasting for 8-12 hours before the procedure
• Adjustments or discontinuation of certain medications as advised by the doctor
• Pre-operative imaging tests like CT or MRI scans to assess the tumor location and size
• Blood tests and a complete medical evaluation

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the lung and tumor.
3. Parts of the chest wall, including ribs, may be removed to fully expose the tumor.
4. The tumor is carefully excised along with surrounding tissues, blood vessels, and nerves.
5. The surgical area is closed with sutures or staples without reconstructing the chest wall.

Duration

The procedure typically takes between 3 to 6 hours.

Setting

This surgery is performed in a hospital operating room.

Personnel

• Thoracic surgeon
• Surgical nurses
• Anesthesiologist
• Possibly a vascular surgeon if complex blood vessel involvement is anticipated

Risks and Complications

• Infection
• Bleeding
• Damage to surrounding organs and tissues
• Respiratory complications
• Persistent pain at the surgical site
• Prolonged recovery time

Benefits

• Removal of the cancerous tumor
• Potential for increased survival
• Alleviation of symptoms caused by the tumor compressing nearby structures Benefits are often realized over several weeks to months as recovery progresses.

Recovery

• Hospital stay for 5-7 days post-surgery
• Pain management with prescribed medication
• Breathing exercises and physical therapy
• Avoid heavy lifting and strenuous activities for several weeks
• Follow-up appointments to monitor recovery and check for cancer recurrence

Alternatives

• Chemotherapy and radiation therapy
• Less invasive surgical options if the tumor is smaller
• Palliative care for symptom management without surgery

Patient Experience

The patient will be under general anesthesia during the procedure and will not feel pain. Post-surgery, pain and discomfort are expected but managed with medication. The recovery period involves rest, limited physical activity, and follow-up care to ensure proper healing and monitor for complications.