Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed
CPT4 code
Name of the Procedure:
Resection (Tumor Debulking) of Recurrent Ovarian, Tubal, Primary Peritoneal, Uterine Malignancy with Omentectomy
Summary
In layman's terms, this procedure involves surgically removing a portion of a tumor to reduce its size and alleviate symptoms associated with recurrent ovarian, tubal, primary peritoneal, or uterine cancers. Part of the omentum (a fatty layer in the abdomen) may also be removed. This is typically performed to enhance the effectiveness of other treatments like chemotherapy.
Purpose
This procedure is aimed at managing recurrent malignancies within the abdomen and pelvis. The goal is to reduce tumor burden, alleviate symptoms such as pain or bowel obstruction, and potentially improve the effectiveness of other treatments like chemotherapy.
Indications
- Recurrent ovarian, tubal, primary peritoneal, or uterine cancer
- Significant tumor burden causing symptoms
- Failure of other treatments to control tumor growth
- Good overall health making the patient a viable candidate for surgery
Preparation
- Fasting typically required for at least 8 hours prior to surgery.
- Adjustments or temporary cessation of certain medications as advised by the healthcare provider.
- Pre-operative diagnostic imaging (e.g., CT scan, MRI) and blood tests.
Procedure Description
- General anesthesia is administered to ensure the patient is asleep and pain-free.
- A surgical incision is made in the abdomen.
- The surgeon locates and carefully removes as much of the tumor as possible (debulking).
- If an omentectomy is performed, the omentum is also surgically removed.
- The incision is closed with sutures or staples, and dressings are applied.
Specialized surgical instruments and imaging tools may be used to help guide the procedure and ensure thorough removal of the tumor tissue.
Duration
The procedure typically lasts between 3 to 6 hours, depending on the extent of tumor growth and the complexity of the case.
Setting
This surgery is performed in a hospital's operating room.
Personnel
- Surgeon specialized in gynecologic oncology or surgical oncology
- Anesthesiologist
- Surgical nurses
- Possibly a second surgeon or surgical assistant
Risks and Complications
- Common risks include infection, bleeding, and blood clots.
- Rare but serious complications may involve injury to surrounding organs, anesthesia complications, or prolonged recovery time.
- Possible management includes antibiotics for infection, blood transfusions for significant blood loss, and additional surgery if complications arise.
Benefits
- Reduction in tumor size to alleviate symptoms.
- Improved efficacy of subsequent treatments like chemotherapy.
- Potential for increased survival time and enhanced quality of life.
- Symptom relief usually is realized shortly after recovery from surgery.
Recovery
- Hospital stay of several days to a week.
- Pain management with prescribed medications.
- Gradual return to normal activities over 4 to 6 weeks.
- Follow-up appointments for evaluation and removal of stitches if needed.
- Instructions on wound care and activity restrictions to support recovery.
Alternatives
- Chemotherapy: Less invasive but may not be as immediately effective for large tumor burdens.
- Radiation: Can be effective for certain cancers but may not be suitable for extensive tumor spread.
- Palliative care: Focuses on symptom management without attempting to remove the tumor, providing relief but not extending survival.
Patient Experience
During the procedure, the patient will be under general anesthesia and unaware of the process. Post-procedure, patients may experience pain and discomfort at the incision site, managed with pain relief medications. Full recovery typically involves a period of rest, careful wound care, and gradual resumption of daily activities. Regular follow-ups will ensure proper healing and monitor for any recurrence of the malignancy.