21601 Excision of chest wall tumor including rib(s)

Name of the Procedure:

Excision of Chest Wall Tumor Including Rib(s)
Common names: Chest wall tumor resection, thoracic surgery for tumor removal.

Summary

This surgical procedure involves removing a tumor from the chest wall, which may include excising a portion of affected ribs. It aims to entirely remove the malignant or benign growth to prevent the spread of disease and alleviate symptoms.

Purpose

This procedure addresses the presence of tumors in the chest wall, which could be cancerous or non-cancerous. The goals are to remove the tumor, ensure clean margins to minimize the risk of recurrence, and relieve associated symptoms like pain or breathing difficulties.

Indications

• Presence of a malignant tumor (e.g., sarcoma, metastasis) or benign mass causing symptoms.
• Symptoms such as chest pain, swelling, breathing difficulties, or visible lumps.
• Imaging studies (e.g., CT scans, MRIs) indicating tumor presence.
• Biopsy confirming tumor type and potential invasiveness.

Preparation

• Patients may be instructed to fast for 8 hours before the procedure.
• Medication adjustments might be necessary, including cessation of blood thinners.
• Preoperative assessments, including blood tests, ECG, and imaging studies, to evaluate overall health and surgical readiness.
• Discussion of anesthesia options and obtaining informed consent.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Incision: The surgeon makes an incision over the affected area on the chest wall.
3. Excision: The tumor, along with some surrounding healthy tissue and possibly one or more ribs, is carefully removed.
4. Reconstruction: Depending on the size of the defect, reconstruction of the chest wall using synthetic mesh or grafts may be necessary.
5. Closure: The incision is closed with sutures or staples, and a drainage tube may be placed to remove excess fluids.

Typical surgical tools include scalpels, rib shears, retractors, and sutures.

Duration

The procedure usually takes between 2 to 4 hours, depending on the complexity and extent of the tumor.

Setting

This surgery is typically performed in a hospital operating room.

Personnel

• Surgeons specialized in thoracic surgery.
• Anesthesiologists for administering and monitoring anesthesia.
• Surgical nurses and operating room technicians.
• Postoperative care team, including recovery room nurses.

Risks and Complications

• Common risks: Bleeding, infection, pain, and scarring.
• Rare risks: Pneumothorax (collapsed lung), recurrence of the tumor, complications from anesthesia, and chronic pain.
• Possible complications: Respiratory distress, wound healing issues, need for further surgeries for reconstruction or complications.

Benefits

• Complete removal of the tumor can potentially cure the condition or significantly slow progression.
• Relief from symptoms such as pain, difficulty breathing, or swelling.
• Improved quality of life and prognosis.

Recovery

• Post-procedure care includes monitoring in a recovery room, pain management, and care for the surgical site.
• Hospital stay ranges from 3 to 7 days, depending on the procedure's complexity and individual patient recovery.
• Patients may need to follow specific care instructions, such as wound care, physical restrictions, and breathing exercises.
• Follow-up appointments to monitor healing and overall health.

Alternatives

• Non-surgical treatments: Radiation therapy, chemotherapy, or a combination of both, especially for inoperable tumors.
• Palliative care: Symptom management without attempting to remove the tumor. Pros and cons of alternatives should be discussed with the treating physician, considering factors like tumor type, location, and patient health.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel or be aware of the surgery.
• Post-procedure: Patients may experience pain, swelling, and fatigue, which are managed with medications.
• Pain management: Includes analgesics and other comfort measures like wound care and physical therapy.
• Emotional support: Professional counseling or support groups may be beneficial for coping with the psychological impact of undergoing major surgery.