58240 Pelvic exenteration for gynecologic malignancy, with total abdominal hysterectomy or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), with removal of bladder and ureteral transplantations, and/or abdominoperineal rese

Name of the Procedure:

Pelvic Exenteration for Gynecologic Malignancy with Total Abdominal Hysterectomy or Cervicectomy, with or without Removal of Tube(s), with or without Removal of Ovary(s), with Removal of Bladder and Ureteral Transplantations, and/or Abdominoperineal Resection.

Summary

Pelvic exenteration is an extensive surgical procedure aimed at removing multiple organs and tissues from the pelvic region to treat advanced gynecologic cancers. The surgery involves the removal of the uterus, cervix, and possibly the fallopian tubes and ovaries along with the bladder and parts of the colon and rectum.

Purpose

The procedure is designed to treat advanced or recurrent gynecologic cancers that have spread within the pelvic region and are not responsive to other treatment forms. The main goal is to eliminate all cancerous tissues to improve or extend the patient's life expectancy.

Indications

• Advanced or recurrent gynecologic cancers (e.g., cervical, ovarian, uterine cancer).
• Cancer that has spread locally to adjacent organs like the bladder or rectum.
• Failure of previous treatments such as radiation or chemotherapy.
• Patients in reasonable overall health to withstand a major surgery.

Preparation

1. Pre-surgical consultations with the oncology, surgical, and anesthesia teams.
2. Blood tests, imaging studies (like CT or MRI scans), and sometimes a colonoscopy or cystoscopy.
3. Bowel preparation to clean the intestines.
4. Fasting for at least 8 hours before the surgery.
5. Medication adjustments as instructed by the healthcare provider.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is completely asleep and pain-free.
2. Incisions: A large abdominal incision is made to access the pelvic organs.
3. Resection: The surgeon removes the uterus, cervix, and may also remove the fallopian tubes, ovaries, bladder, and portions of the rectum and colon.
4. Reconstruction: Reconstructive steps may include creating a new pathway for urine (urostomy) and stool (colostomy) with the transplantation of ureters as necessary.
5. Closure: The incisions are closed with sutures or staples, and drainage tubes may be placed to remove excess fluids.

Duration

The procedure can take anywhere from 8 to 12 hours, depending on its complexity and the extent of cancer's spread.

Setting

The surgery is performed in a hospital setting equipped with advanced surgical facilities and postoperative intensive care units.

Personnel

• Surgical oncologist
• Gynecologic surgeon
• Anesthesiologist
• Scrub nurses and surgical techs
• Postoperative care team (nurses, physical therapists)

Risks and Complications

• Common risks include infection, bleeding, and wound complications.
• Rare but severe complications include blood clots, organ injury, and adverse reactions to anesthesia.
• Long-term complications might involve urinary or bowel dysfunction, sexual dysfunction, or the need for additional surgeries.

Benefits

• Potential removal of all cancerous tissues.
• Extending life expectancy.
• Improving the quality of life by alleviating symptoms caused by the cancer.

Recovery

• Patients will stay in the hospital for 1 to 2 weeks for intensive monitoring.
• Full recovery may take several months.
• Post-procedure care includes wound care, pain management, physical therapy, and follow-up appointments.
• Restrictions include limited physical activity and gradual return to daily activities.

Alternatives

• Other treatments like chemotherapy, radiation therapy, or less extensive surgical procedures.
• Palliative care for symptom management without curative intent.
• Each alternative has varying success rates, side effects, and impact on quality of life.

Patient Experience

• The patient will be under general anesthesia during the surgery, hence will not feel anything.
• Postoperatively, patients may experience significant pain managed through medications.
• Over time, patients adapt to changes resulting from organ removals, such as living with a colostomy or urostomy.
• Emotional and psychological support is often necessary due to the major lifestyle changes.