Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure)
CPT4 code
Name of the Procedure:
Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy
Summary
Thoracic lymphadenectomy by thoracotomy is a surgical procedure involving the removal of lymph nodes located within the chest, specifically in the mediastinal and surrounding regions. This procedure is often performed via a thoracotomy, which is an incision into the chest wall.
Purpose
This procedure addresses medical conditions such as lung cancer, lymphoma, or metastasis from other cancers where lymph nodes need to be examined or removed. The goal is to remove cancerous or suspicious lymph nodes to prevent the spread of disease and to allow for accurate staging and treatment planning.
Indications
- Lung cancer or suspected lung cancer
- Lymphoma
- Metastatic cancer in the chest lymph nodes
- Enlarged or abnormal lymph nodes observed in imaging studies
Preparation
- Patients are typically instructed to fast for at least 8 hours before the procedure.
- Adjustments to regular medications, especially blood thinners, as advised by the healthcare provider.
- Pre-operative imaging studies and blood tests to assess overall health and to map lymph node locations.
Procedure Description
- The patient is placed under general anesthesia.
- A thoracotomy incision is made in the chest wall to provide access to the thoracic cavity.
- The surgeon identifies and removes the targeted lymph nodes from the mediastinal and regional areas.
- The removed lymph nodes are sent to a pathology lab for analysis.
- The incision is closed with sutures or staples, and a drainage tube may be placed to prevent fluid build-up.
Duration
The procedure typically takes between 2 to 4 hours, depending on the extent of lymph node removal and complexity.
Setting
This procedure is performed in a hospital operating room.
Personnel
- Cardiothoracic surgeon
- Anesthesiologist
- Surgical nurses
- Pathologist (for lymph node analysis)
Risks and Complications
- Bleeding
- Infection
- Damage to nearby organs and tissues
- Prolonged air leaks
- Respiratory complications
- Pain at the incision site
Benefits
- Accurate staging of cancer
- Potentially curative for localized cancer
- Prevention of cancer spread
- Better informed treatment planning Results from pathology can usually be expected within few days to a week.
Recovery
- Hospital stay of 3-7 days post-procedure.
- Pain management with prescribed medications.
- Instructions for wound care and activity restrictions.
- Follow-up care to monitor recovery, remove drainage tubes, and review pathology results.
- Full recovery may take 4-6 weeks with gradual return to normal activities.
Alternatives
- Less invasive procedures like video-assisted thoracoscopic surgery (VATS) for lymph node biopsy or removal.
- Needle biopsy guided by imaging.
- Radiation or chemotherapy for non-surgical candidates. Pros of alternatives include less invasive nature and quicker recovery, but they may not be as comprehensive for staging or removing cancerous tissue.
Patient Experience
- During the procedure: The patient will be asleep and feel no pain due to general anesthesia.
- After the procedure: The patient may feel pain or discomfort at the incision site, which will be managed with pain medications.
- Short-term discomfort from the thoracotomy incision and any chest tubes placed.
- Gradual improvement in breathing and energy levels as recovery progresses. Pain management and support from the healthcare team will be provided to ensure comfort during the recovery period.