Resection of apical lung tumor (eg, Pancoast tumor), including chest wall resection, rib(s) resection(s), neurovascular dissection, when performed; with chest wall reconstruction
CPT4 code
Name of the Procedure:
Resection of Apical Lung Tumor (e.g., Pancoast Tumor) with Chest Wall Reconstruction
Summary
This procedure involves the surgical removal of a tumor located at the top (apex) of the lung, which may include the resection of parts of the chest wall, ribs, and any associated neurovascular structures. After removing the tumor and affected areas, the chest wall is reconstructed to ensure structural integrity and proper function.
Purpose
The procedure primarily addresses apical lung tumors, such as Pancoast tumors, which are typically located at the top part of the lung and may involve nearby structures. The goals are to completely remove the tumor, alleviate symptoms, and prevent the spread of cancer, thereby improving the patient's chances of survival and quality of life.
Indications
- Presence of an apical lung tumor (Pancoast tumor) confirmed by imaging and biopsy.
- Symptoms such as shoulder pain, arm pain or weakness, and Horner's syndrome (a combination of drooping eyelid, constricted pupil, and lack of sweating on one side of the face).
- Tumors that have not responded to, or are not suitable for, other treatments like chemotherapy or radiation alone.
- Good general health to withstand a major surgical procedure.
Preparation
- Fasting for at least 8 hours before surgery.
- Adjustments to current medications as advised by the healthcare provider.
- Preoperative imaging studies (CT scans, MRI) and pulmonary function tests.
- Blood tests and other routine preoperative assessments.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is completely unconscious and pain-free.
- Incision: A surgical incision is made in the chest to access the tumor.
- Tumor Resection: The tumor and affected tissues, including parts of the chest wall, ribs, and possibly neurovascular structures, are carefully removed.
- Chest Wall Reconstruction: Materials such as synthetic mesh, metal plates, or bone grafts are used to reconstruct the chest wall, ensuring stability and function.
- Closure: The incision is closed with sutures or staples, and a drainage tube may be placed to remove fluids from the surgical area.
Duration
The procedure generally takes 4 to 6 hours, depending on the complexity and extent of the tumor and reconstruction required.
Setting
This surgery is performed in a hospital operating room, often in a specialized thoracic surgical center.
Personnel
- Cardiothoracic surgeon
- Thoracic surgical team (assistants, scrub nurses)
- Anesthesiologist
- Operating room nurses and technologists
Risks and Complications
- Common risks: bleeding, infection, pain, respiratory issues.
- Rare risks: damage to nearby organs or nerves, prolonged air leak, failure of the chest wall reconstruction, blood clot formation.
- Complications are managed based on their occurrence and severity.
Benefits
- Complete removal of the tumor can improve survival rates.
- Symptom relief and improved quality of life.
- Potential prevention of cancer spread. Benefits may be realized shortly after recovery, but full assessment occurs over follow-up appointments.
Recovery
- Hospital stay: Typically 7-10 days.
- Pain management with medications.
- Breathing exercises and physical therapy.
- Restrictions on heavy lifting and strenuous activities.
- Follow-up appointments to monitor recovery and assess for any complications.
- Full recovery may take several weeks to a few months.
Alternatives
- Chemotherapy and radiation therapy alone.
- Less invasive surgeries if the tumor is smaller or more accessible.
- Palliative care in cases where surgery is not feasible. Each alternative has its specific pros and cons, varying efficacy, and suitability based on individual patient conditions.
Patient Experience
During the procedure, the patient will be under general anesthesia and will not feel any pain. Post-procedure, patients will experience some pain and discomfort managed by medications. A hospital stay is required for monitoring and initial recovery, followed by home care instructions to ensure complete healing. Pain management and gradual return to normal activities are emphasized to ensure a smooth recovery process.