Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination there
CPT4 code
Name of the Procedure:
Pelvic Exenteration, Complete (Also known as Total Pelvic Exenteration)
Summary
Pelvic exenteration is a radical surgical procedure that involves the removal of multiple organs and structures within the pelvic cavity. This procedure is often performed to treat advanced vesical (bladder), prostatic (prostate), or urethral malignancies. Depending on the specifics of the case, it may include the removal of the bladder, parts of the ureters, and possibly the rectum, colon, and reproductive organs, as well as the creation of a colostomy.
Purpose
Pelvic exenteration aims to remove all cancerous tissues in patients with advanced pelvic malignancies in order to achieve a cure or significant disease control. The radical nature of the procedure is intended to offer a chance for extended survival or complete remission when other treatments are inadequate.
Indications
- Advanced or recurrent cancers of the bladder, prostate, or urethra.
- Cases where cancer has spread to multiple pelvic organs.
- Patients who have not responded to previous treatments such as radiation or chemotherapy.
Preparation
- Complete fasting for at least 8 hours before surgery.
- Adjustments to medications as directed by the healthcare team.
- Preoperative imaging studies (CT scan, MRI, PET scan) for surgical planning.
- Bowel preparation to empty the intestines.
- Meeting with the anesthesiologist to discuss sedation and pain management.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made in the lower abdomen to access the pelvic cavity.
- The bladder is removed along with the cancerous tissues.
- The surgeon may remove the prostate, urethra, and surrounding lymph nodes.
- The rectum and parts of the colon may be resected.
- Ureteral transplantations are performed if needed, rerouting the ureters to a new location.
- A colostomy is created if the colon or rectum is removed.
- Additional removal of reproductive organs may be performed, depending on the patient's gender and cancer spread.
- The surgical site is closed, and a recovery plan is initiated.
Duration
The procedure typically takes 8 to 12 hours, depending on the extent of surgery needed.
Setting
Pelvic exenteration is performed in a hospital setting, specifically in a sterile operating room equipped for major surgeries.
Personnel
- Lead surgeon (specializing in oncologic or urologic surgeries)
- Assistant surgeons
- Anesthesiologist
- Surgical nurses
- Operating room technicians
- Post-operative care team
Risks and Complications
- Infection
- Bleeding
- Deep vein thrombosis (DVT) or pulmonary embolism (PE)
- Damage to surrounding organs
- Prolonged recovery period
- Short-term or long-term urinary or bowel dysfunction
- Possible need for additional corrective surgeries
Benefits
- Potential complete removal of cancerous tissues.
- Increased chance of long-term survival or remission.
- Relief from symptoms caused by advanced malignancies.
Recovery
- Hospital stay for 1 to 2 weeks post-surgery.
- Pain management with medications.
- Gradual return to eating and moving around.
- Instructions on how to manage colostomy or urostomy care.
- Restricted activity for several weeks, with gradual return to normal activities.
- Follow-up appointments to monitor recovery and detect any recurrence of cancer.
Alternatives
- High-dose radiation therapy
- Chemotherapy
- Targeted therapy
- Minimally invasive surgeries (when appropriate)
- Palliative care for symptom management without attempting curative surgery
Patient Experience
- Patients will feel sore and must manage new bodily functions (e.g., colostomy care).
- Pain control will be provided through medications and, if necessary, a pain specialist.
- Emotional support and counseling may be beneficial due to the radical nature of the surgery and its impact on quality of life.