38765 Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

Name of the Procedure:

Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

Summary

Inguinofemoral lymphadenectomy with pelvic lymphadenectomy is a surgical procedure to remove lymph nodes from the groin (inguinofemoral area) and the pelvis. This helps in managing and staging cancers originating from or spreading to these anatomical regions.

Purpose

This procedure addresses cancers that may involve lymph nodes in the groin and pelvic regions. The goal is to remove affected lymph nodes to prevent the spread of cancer and accurately stage the disease, which helps in planning further treatments.

Indications

• Presence of metastatic cancer in the lymph nodes from cancers such as melanoma, cervical cancer, or vulvar cancer.
• Enlarged lymph nodes detected via imaging or biopsy.
• Recurrent cancer in the pelvic or inguinal regions.

Preparation

• Patients are usually required to fast for at least 8 hours prior to the procedure.
• Medication adjustments may be necessary, particularly concerning blood thinners.
• Pre-operative assessments include blood tests, imaging studies (CT, MRI), and sometimes, a biopsy of the lymph nodes.

Procedure Description

1. Anesthesia: The patient is administered general anesthesia.
2. Incision: An incision is made in the groin area to access the inguinal and femoral lymph nodes.
3. Lymph Node Removal: The superficial inguinofemoral lymph nodes are surgically excised.
4. Exposure of Pelvic Nodes: The procedure continues with additional incisions to access and remove the pelvic lymph nodes, including those in the external iliac, hypogastric, and obturator regions.
5. Closure: The surgical sites are closed with sutures or staples, and dressings are applied.

Duration

The procedure typically takes between 3 to 5 hours, depending on the extent of lymph node involvement and individual patient circumstances.

Setting

This surgery is performed in a hospital's operating room.

Personnel

• Lead Surgeon
• Surgical Assistants
• Anesthesiologist
• Scrub Nurses
• Circulating Nurses

Risks and Complications

• Common Risks: Infection, bleeding, seroma (fluid accumulation), and lymphocele.
• Rare Risks: Deep vein thrombosis, damage to nearby structures, and prolonged lymphedema (swelling due to lymph fluid).

Benefits

• Removal of affected lymph nodes to control cancer spread.
• Accurate staging of cancer, guiding further treatment decisions.
• Potentially prolonged survival and improved quality of life.

Recovery

• Post-Procedure: The patient is monitored in a recovery room and may need to stay in the hospital for a few days.
• Care Instructions: Wound care, activity restrictions, and possibly drainage care.
• Recovery Time: Full recovery typically takes 4-6 weeks, with some limitations on physical activities.
• Follow-up appointments are necessary for wound check and to monitor for any complications or recurrence.

Alternatives

• Radiation Therapy: Targeted radiation to lymph node regions.
• Chemotherapy: Systemic treatment to target cancer cells.
• Pros and Cons: While less invasive, non-surgical treatments may not be as effective in removing or diagnosing the extent of lymph node involvement.

Patient Experience

During the procedure, the patient is under anesthesia and will not feel pain. Postoperatively, there might be pain and discomfort at the surgical sites, managed with prescribed pain medications. Patients may experience temporary swelling, bruising, and limited mobility which will improve with time and rehabilitation.