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Pharyngolaryngectomy, with radical neck dissection; without reconstruction

CPT4 code

Name of the Procedure:

Pharyngolaryngectomy with Radical Neck Dissection (without reconstruction)

Summary

Pharyngolaryngectomy with radical neck dissection is a major surgical procedure that involves removing the pharynx (throat) and larynx (voice box), along with a comprehensive dissection of lymph nodes and surrounding tissues in the neck. This procedure is typically performed without immediate tissue or structural reconstruction.

Purpose

This procedure is primarily intended to treat advanced cancers of the pharynx and larynx. The goal is to remove the cancerous tissues completely to prevent the spread of the disease, thus improving the chances of survival and reducing symptoms associated with the cancer.

Indications

  • Diagnosed advanced stage cancer of the pharynx or larynx.
  • Recurrence of cancer after previous treatments.
  • Large tumors that have metastasized to lymph nodes in the neck. Patients are generally considered for this procedure when less invasive treatments are not viable or have failed.

Preparation

  • Patients are usually required to fast for at least 8 hours prior to the surgery.
  • Medication adjustments may be necessary, especially blood thinners.
  • Pre-operative assessments often include blood tests, imaging studies (CT, MRI, or PET scans), and a complete physical examination.

Procedure Description

  1. Anesthesia: The patient is given general anesthesia to be completely unconscious during the procedure.
  2. Incisions: Multiple incisions are made in the neck to access the pharynx and larynx.
  3. Removal: The surgeon removes the pharynx and larynx along with affected lymph nodes and nearby tissues.
  4. Hemostasis: Bleeding is controlled, and all blood vessels are carefully sealed.
  5. Closure: The incisions are closed with sutures or staples, leaving the neck area without a reconstruction of the removed parts.

Duration

The procedure typically takes 8 to 10 hours, depending on the complexity and the extent of tissue involvement.

Setting

Performed in a hospital's surgical suite equipped for major surgeries.

Personnel

  • Lead Surgeon (ENT or Head and Neck Cancer Specialist)
  • Surgical assistants
  • Anesthesiologist
  • Operating room nurses
  • Support and recovery staff

Risks and Complications

  • Common: Infection, bleeding, blood clots, issues with wound healing, and difficulties swallowing.
  • Rare: Damage to nearby tissues and organs, respiratory complications, prolonged swallowing difficulties, and necessity for tracheostomy (breathing tube).

Benefits

  • Effective removal of cancerous tissue, which may increase survival rates.
  • Reduction in symptoms caused by the tumor, such as difficulty breathing or swallowing.
  • Can prevent further spread of the cancer.

Recovery

  • Hospital stay of 1-2 weeks is typical.
  • Patients will receive nutrition through a feeding tube initially.
  • Pain management with prescribed medications.
  • Strict avoidance of strenuous activity during the early recovery period.
  • Regular follow-up appointments for wound care and monitoring healing progress.
  • Rehabilitation for speech and swallowing functions may be necessary.

Alternatives

  • Radiation therapy: Non-surgical option using high-energy rays to kill cancer cells.
  • Chemotherapy: Use of drugs to target and kill cancer cells.
  • Partial laryngectomy: Less extensive surgery preserving some of the larynx. Each alternative has its pros and cons, often with lower efficacy in advanced cancer stages compared to pharyngolaryngectomy with radical neck dissection.

Patient Experience

  • During the procedure, patients will be under general anesthesia and will not feel any pain.
  • Post-procedure discomfort can be managed with medications.
  • Initial dependence on feeding tubes and potential need for a temporary tracheostomy.
  • Emotional and physical rehabilitation support is crucial for recovery.

This procedure, though extensive, provides a critical chance at controlling or eradicating advanced cancer.

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