19272 Excision of chest wall tumor involving ribs, with plastic reconstruction; with mediastinal lymphadenectomy

Name of the Procedure:

Excision of Chest Wall Tumor Involving Ribs with Plastic Reconstruction and Mediastinal Lymphadenectomy

Summary

This procedure involves surgically removing a tumor from the chest wall, including affected ribs, and reconstructing the area with plastic surgery techniques. Additionally, lymph nodes in the mediastinum (central part of the chest) are removed. This comprehensive approach addresses both the primary tumor and potential spread of disease.

Purpose

• Medical Condition: Chest wall tumors, which may be benign or malignant.
• Goals: To completely remove the tumor and affected tissues, assess and address potential spread to lymph nodes, and rebuild the structural integrity of the chest wall for functional and aesthetic outcomes.

Indications

• Presence of a tumor in the chest wall that involves the ribs.
• Evidence or suspicion of cancer spread to the mediastinal lymph nodes.
• Symptoms such as localized chest pain, swelling, or deformity.

Preparation

• Instructions: Patients may be advised to fast for 8-12 hours prior to surgery.
• Medications: Adjustments to current medications, especially blood thinners, may be necessary.
• Tests: Imaging studies such as CT or MRI scans, blood tests, and sometimes a biopsy to evaluate the tumor.

Procedure Description

1. Anesthesia: General anesthesia is administered.
2. Incision: A surgical incision is made near the tumor site.
3. Excision: The tumor and affected ribs are carefully removed.
4. Lymphadenectomy: Mediastinal lymph nodes are excised for pathological assessment.
5. Reconstruction: Plastic surgery techniques, possibly involving grafts or prosthetics, are used to reconstruct the chest wall.
6. Closure: The incision is closed with sutures or staples and dressed.

Duration

• Typically takes 4-8 hours, depending on the complexity.

Setting

• Normally performed in a hospital's surgical suite.

Personnel

• Surgeons, specifically thoracic and plastic surgeons.
• Anesthesiologists.
• Surgical nurses and possibly a surgical technologist.

Risks and Complications

• Common: Infection, bleeding, pain, scarring.
• Rare: Respiratory complications, injury to nearby organs, anesthetic complications, and recurrence of the tumor.

Benefits

• Potential complete removal of the tumor and affected tissues.
• Diagnosis and management of any lymph node involvement.
• Restoration of chest wall structure, improving function and appearance.
• Benefits are usually realized immediately after recovery and healing.

Recovery

• Care: Monitoring in the hospital for several days.
• Instructions: Pain management, wound care, avoid strenuous activities.
• Recovery Time: Several weeks to months, with follow-up appointments to monitor healing and assess for any complications.

Alternatives

• Non-surgical options like chemotherapy or radiotherapy, which may be less invasive but could be less effective for certain tumors.
• Palliative care for symptom management if surgery is not viable.
• Pros and cons vary, with surgery providing a potential cure but involving higher immediate risks.

Patient Experience

• During: The patient will be unconscious under general anesthesia.
• After: Discomfort and pain managed with medications; limited physical activity initially.
• Pain Management: Effective methods, including medications and possibly nerve blocks, will be used to minimize pain and ensure patient comfort.