Excision of chest wall tumor involving ribs, with plastic reconstruction; without mediastinal lymphadenectomy
CPT4 code
Name of the Procedure:
Excision of Chest Wall Tumor Involving Ribs with Plastic Reconstruction (without Mediastinal Lymphadenectomy)
Summary
This surgical procedure involves removing a tumor located in the chest wall, which includes removing a section of the rib(s) as well, followed by reconstructing the removed area using plastic surgical techniques. This process does not include the removal of lymph nodes in the mediastinum.
Purpose
The procedure is primarily aimed at treating malignancies or benign tumors of the chest wall that involve the ribs. The goals are to completely remove the tumor, minimize the risk of recurrence, and restore the structural integrity and appearance of the chest wall.
Indications
- Presence of a chest wall tumor confirmed through imaging and biopsy.
- Symptoms such as localized pain, swelling, or difficulty breathing.
- Tumors that have not metastasized to the mediastinal lymph nodes.
- Suitable candidates include patients who are in overall good health and can tolerate surgery.
Preparation
- Patient should fast for at least 8 hours prior to the procedure.
- Preoperative imaging tests such as CT or MRI scans to evaluate the tumor.
- Blood tests and other routine diagnostic assessments.
- Stopping certain medications as instructed by the healthcare provider.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A surgical incision is made over the affected area of the chest.
- Tumor Excision: The tumor, along with a segment of the rib(s), is meticulously removed.
- Reconstruction: Using plastic surgery techniques, the chest wall is reconstructed to maintain structural integrity and aesthetic appearance. This may involve the use of synthetic materials or grafts.
- Closure: The incision is closed with sutures or staples, and sterile dressings are applied.
Duration
The procedure typically takes between 3 to 6 hours, depending on the complexity and extent of the reconstruction.
Setting
This surgery is typically performed in a hospital operating room.
Personnel
- Cardiothoracic surgeon or surgical oncologist
- Plastic surgeon
- Anesthesiologist
- Surgical nurses
- Operating room technicians
Risks and Complications
- Common: Pain, infection, bleeding, and wound complications.
- Rare: Lung complications, incomplete removal of the tumor, reaction to anesthesia, and recurrence of the tumor.
- Management: Risks are managed with antibiotics, pain relief medications, and close postoperative monitoring.
Benefits
- Complete removal of the tumor with reduced risk of recurrence.
- Restoration of chest wall stability and appearance.
- Improved quality of life if symptoms were present.
Recovery
- Hospital stay of about 5 to 7 days post-surgery.
- Pain management with prescribed medications.
- Instructions on wound care and activity restrictions.
- Follow-up appointments for monitoring recovery and potential additional treatments like chemotherapy or radiotherapy if necessary.
- Expected full recovery may take several weeks to months.
Alternatives
- Chemotherapy or radiotherapy alone, which may be less invasive but potentially less effective for certain tumors.
- Cryoablation or radiofrequency ablation for smaller tumors.
- Observation for asymptomatic, benign tumors.
Patient Experience
- During the procedure: The patient will be under general anesthesia and will not feel any pain.
- Post-procedure: Patients may experience pain and discomfort managed with medications. Possible chest tightness or difficulty with deep breaths which should improve over time.
- Comfort measures include supportive care, breathing exercises, and regular follow-up to ensure proper healing.