21602 Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomy

Name of the Procedure:

Excision of Chest Wall Tumor Involving Rib(s) with Plastic Reconstruction (Without Mediastinal Lymphadenectomy)

Summary

This surgical procedure involves the removal of a tumor located on the chest wall that may involve one or more ribs. This is followed by reconstructive surgery to restore the structure and appearance of the chest wall. The procedure does not include the removal of lymph nodes in the mediastinum (the central part of the chest cavity).

Purpose

This procedure addresses malignant or benign tumors located on the chest wall which may have invaded adjacent ribs. The goal is to entirely remove the tumor, prevent its spread, and restore both the function and appearance of the chest wall.

Indications

• Presence of a chest wall mass confirmed to be a tumor.
• Symptoms such as chest pain, breathing difficulty, or noticeable deformity.
• Diagnosis of cancer or other conditions affecting the structural integrity of the chest wall.
• Criteria include the tumor’s size, location, and invasion of adjacent structures.

Preparation

• Fasting for at least 8 hours before surgery.
• Adjustments or cessation of certain medications as advised by the physician.
• Pre-operative imaging studies such as CT scans or MRIs.
• Blood tests and cardiovascular assessments to ensure patient readiness for surgery.

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia.
2. Incision: A surgical incision is made on the chest to access the tumor.
3. Excision: The surgeon carefully removes the tumor, including any involved portions of the ribs.
4. Reconstruction: Plastic surgeons reconstruct the chest wall using synthetic materials, bone grafts, or muscle flaps to restore its structural integrity and appearance.
5. Closure: The incision is closed with sutures or staples and covered with sterile dressings.

Duration

The procedure typically takes 3-6 hours, depending on the tumor’s size and complexity of the reconstruction.

Setting

This surgery is performed in a hospital operating room equipped with advanced surgical and anesthesia capabilities.

Personnel

• Thoracic surgeon
• Plastic or reconstructive surgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists

Risks and Complications

• Common Risks: Infection, bleeding, and pain at the surgical site.
• Rare Risks: Damage to adjacent organs (e.g., lungs, heart), impaired respiratory function, and complications from anesthesia.
• Management: Close post-operative monitoring, pain management protocols, and antibiotics to prevent infection.

Benefits

• Removal of the tumor minimizes the risk of cancer spread.
• Restored structural and cosmetic integrity of the chest wall.
• Improvement in symptoms such as pain or breathing difficulties, typically within weeks post-surgery.

Recovery

• Hospital stay of 5-7 days post-surgery.
• Instructions include wound care, restricted physical activity, and breathing exercises.
• Pain management plan will be provided.
• Follow-up appointments for monitoring recovery and detecting any complications.
• Full recovery may take several weeks to months, depending on individual patient factors and extent of surgery.

Alternatives

• Radiation Therapy: For inoperable tumors or as adjunct therapy.
• Chemotherapy: As primary or supplemental treatment for malignant tumors.
• Cryoablation: Freezing the tumor, usually for localized and smaller tumors.
• Pros and Cons: Alternatives may offer less invasive options but might not completely remove the tumor or restore structural integrity as effectively.

Patient Experience

• During the procedure, the patient will be under general anesthesia and will not feel any pain.
• Post-operatively, they may experience pain, swelling, and limited mobility in the chest area, managed with medications.
• Emotional support, counseling, and physical therapy may be recommended to aid overall recovery and adjustment.