Inguinofemoral lymphadenectomy, superficial, including Cloquet's node (separate procedure)
CPT4 code
Name of the Procedure:
Inguinofemoral Lymphadenectomy, Superficial, including Cloquet's Node (Separate Procedure)
Summary
Inguinofemoral lymphadenectomy is a surgical procedure that involves the removal of lymph nodes from the groin and upper thigh areas. This includes the Cloquet's node, which is located near the upper part of the femoral canal. The procedure is performed to treat or diagnose certain cancers or infections.
Purpose
The primary purpose is to remove lymph nodes that may contain cancerous cells, particularly from melanoma, penile cancer, vulvar cancer, or other malignancies. This helps in staging the spread of cancer and potentially preventing further metastasis. The procedure can also be done to treat chronic infections or other medical issues involving lymph nodes.
Indications
- Presence of cancer in the genital, anal, or lower abdominal regions.
- Suspected or confirmed metastatic melanoma.
- Chronic infections or abscesses in the lymph nodes.
- Enlarged lymph nodes of unknown etiology.
Preparation
- Patients are often instructed to fast for 8-12 hours before the procedure.
- Certain medications, particularly blood thinners, might need to be stopped prior to surgery.
- Pre-operative assessments include blood tests, imaging studies (like CT or MRI scans), and a physical examination.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the groin area.
- The surgeon carefully removes the superficial lymph nodes, including Cloquet's node.
- Special surgical instruments and techniques are used to minimize tissue damage and ensure thorough removal.
- The incision is then closed with sutures or staples, and a drain may be placed to prevent fluid accumulation.
Duration
The procedure typically takes between 1.5 to 3 hours, depending on the extent of lymph node involvement and complexity.
Setting
The procedure is performed in a hospital operating room or a specialized surgical center.
Personnel
- A board-certified surgeon, often specialized in oncologic or general surgery.
- An anesthesiologist to manage anesthesia.
- Surgical nurses and possibly a surgical assistant.
Risks and Complications
- Infection at the surgical site.
- Lymphedema (swelling caused by lymph fluid).
- Blood clots or deep vein thrombosis.
- Nerve damage leading to numbness or loss of sensation.
- Seroma formation (accumulation of fluids).
Benefits
- Accurate staging and treatment of cancer.
- Potential reduction in the spread of cancerous cells.
- Relief from chronic infections and associated symptoms.
- Improved prognosis and potential for long-term remission in cancer patients.
Recovery
- Post-procedure, patients are monitored in a recovery area.
- Pain management may include medications and comfort measures.
- Patients are usually advised to avoid strenuous activities for 4-6 weeks.
- Regular follow-up appointments are necessary to monitor healing and detect any complications.
- Physical therapy may be recommended to manage or prevent lymphedema.
Alternatives
- Sentinel lymph node biopsy, a less invasive procedure for early-stage cancer.
- Radiation therapy, particularly when surgery is not an option.
- Chemotherapy or other systemic treatments may be considered for metastatic disease.
- Pros and cons: Sentinel lymph node biopsy is less invasive but may not be as comprehensive. Radiation can target cancer cells but has its own side effects.
Patient Experience
- During the procedure, the patient will be under general anesthesia and will not feel pain.
- Post-surgery, some discomfort and pain are expected and will be managed with medication.
- Swelling and bruising in the groin area are common.
- Patients may experience a temporary or permanent change in sensation near the surgical site.
- Mobility may be restricted initially, and supportive care such as physical therapy can aid in recovery.