38770 Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)

Name of the Procedure:

Pelvic Lymphadenectomy, including external iliac, hypogastric, and obturator nodes (separate procedure)
Common name(s): Pelvic Lymph Node Dissection (PLND)

Summary

Pelvic lymphadenectomy is a surgical procedure to remove lymph nodes from specific areas in the pelvis: the external iliac, hypogastric (internal iliac), and obturator regions. It's often performed to check for and treat the spread of cancer.

Purpose

Pelvic lymphadenectomy is primarily used to diagnose and treat cancers, particularly those originating in the prostate, bladder, cervix, or other pelvic organs. By removing lymph nodes, doctors can accurately stage cancer, determine its spread, and tailor the treatment plan accordingly.

Indications

• Diagnosis or staging of cancers such as prostate, bladder, or cervical cancer.
• Patients with high-risk or locally advanced cancers.
• Plan development for further cancer treatments, such as chemotherapy or radiation.

Preparation

• Patients may be instructed to fast for a specified period before the procedure.
• Medication adjustments may be necessary, particularly for blood thinners or other chronic medications.
• Pre-procedure imaging or diagnostic tests such as MRI, CT scans, or blood tests to assess the extent of cancer and overall health.

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free during the procedure.
2. A surgical incision is made in the lower abdomen to gain access to the pelvic cavity.
3. Using surgical instruments, the surgeon carefully removes the lymph nodes from the external iliac, hypogastric, and obturator regions.
4. The removed lymph nodes are sent for pathological examination to check for the presence of cancer cells.
5. After ensuring all targeted lymph nodes are removed, the incision is closed with sutures or staples.

Duration

The procedure typically takes 2 to 3 hours.

Setting

Pelvic lymphadenectomy is usually performed in a hospital setting, often within an operating room equipped for major surgeries.

Personnel

• Surgeon specialized in urology or oncology.
• Anesthesiologist responsible for administering anesthesia and monitoring the patient.
• Surgical nurses and assistants to support the surgeon and ensure the surgical field is sterile.

Risks and Complications

• Infection at the surgical site.
• Bleeding or blood clots.
• Injury to surrounding organs or blood vessels.
• Nerve damage leading to leg weakness or pain.
• Lymphocele (accumulation of lymphatic fluid).

Benefits

• Accurate staging of cancer, which is crucial for effective treatment planning.
• Possible reduction in cancer spread by removing affected lymph nodes.
• Increased chances of survival and better management of cancer.

Recovery

• Hospital stay for a few days post-surgery is common.
• Pain management with prescribed medications.
• Instructions on wound care and signs of infection to watch for.
• Activity restrictions, including avoiding heavy lifting and strenuous activities for several weeks.
• Follow-up appointments to monitor recovery and discuss further treatment based on pathology results.

Alternatives

• Imaging studies like MRI or CT scans for non-invasive lymph node assessment (though less accurate).
• Sentinel lymph node biopsy, which is less extensive but may not gather complete staging information.
• Chemotherapy or radiotherapy as primary treatment options, depending on the specific cancer type and stage.

Patient Experience

• General anesthesia will ensure the patient is asleep during the procedure, feeling no pain.
• Post-operative pain and discomfort, managed with medications.
• Possible temporary difficulty in movement and some swelling in the surgical area.
• Close monitoring and support from the healthcare team to ensure smooth recovery.

By following these descriptions, patients and their families can better understand the purpose and process of a pelvic lymphadenectomy, prepare adequately for the procedure, and know what to expect during recovery.