38562 Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic

Name of the Procedure:

Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic

Summary

A limited lymphadenectomy for staging involves the surgical removal of lymph nodes from the pelvic and para-aortic regions to determine the stage of certain cancers. This helps in planning the most effective treatment strategy.

Purpose

This procedure is primarily performed to stage cancers, such as gynecological cancers, to assess the extent of cancer spread. The goal is to identify whether cancer has spread to the lymph nodes, which will influence treatment decisions and prognosis.

Indications

• Diagnosis of gynecological cancers such as ovarian, cervical, or endometrial cancer.
• Presence of enlarged lymph nodes detected through imaging studies.
• Staging before starting cancer treatment to determine the most appropriate therapeutic approach.
• Patients in good general health, with no contraindications to surgery.

Preparation

• Patients may need to fast for a certain period before the procedure.
• Medication adjustments, particularly for those on blood thinners.
• Pre-operative imaging scans to guide the surgical plan.
• Routine blood tests and possibly an electrocardiogram (EKG) to ensure fitness for surgery.

Procedure Description

1. Administration of general anesthesia to ensure the patient is unconscious and pain-free.
2. Small incisions are made in the abdomen.
3. A laparoscope (a thin tube with a camera and light) and surgical instruments are inserted through the incisions.
4. Lymph nodes in the pelvic and para-aortic regions are identified and carefully removed.
5. The removed lymph nodes are sent to a lab for pathological examination.
6. Incisions are sutured closed.

Duration

The procedure typically takes 1 to 3 hours, depending on the extent of lymph node removal and individual patient anatomy.

Setting

This procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeons with expertise in oncologic surgery.
• Anesthesiologist to administer and monitor anesthesia.
• Surgical nurses and assistants to support the operative process.

Risks and Complications

• Common risks include bleeding, infection, and pain at the incision sites.
• Rare complications include lymphocele (fluid collection), damage to nearby organs, and deep vein thrombosis (DVT).
• Management may involve antibiotics for infections, drainage of fluid collections, and monitoring for any signs of complications.

Benefits

• Accurate staging of cancer, which is critical for effective treatment planning.
• Helps in deciding the necessity and extent of additional treatments such as chemotherapy or radiation.
• Generally, staging improves overall prognosis by tailoring treatment strategies.

Recovery

• Patients typically stay in the hospital for 1 to 2 days post-procedure.
• Pain management with prescribed medications.
• Instructions to avoid heavy lifting and strenuous activities for a few weeks.
• Follow-up appointments to assess healing and review pathology results.

Alternatives

• Non-surgical imaging techniques like PET scans or MRI, though they can be less definitive.
• Fine-needle aspiration or core needle biopsy as a less invasive alternative, though these may not provide as comprehensive staging information.

Patient Experience

• During the procedure, patients will be under general anesthesia and will not feel anything.
• Postoperative pain and discomfort are expected but managed with medications.
• Patients may experience some abdominal bloating, fatigue, and mobility restrictions initially.
• Most return to normal activities within 2 to 4 weeks, following guidance from their healthcare provider.