56632 Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy

Name of the Procedure:

Radical Partial Vulvectomy with Bilateral Inguinofemoral Lymphadenectomy

Summary

A radical partial vulvectomy with bilateral inguinofemoral lymphadenectomy is a surgical procedure where part of the vulva is removed, along with lymph nodes in both sides of the groin, to treat cancer while preserving as much normal tissue as possible.

Purpose

This procedure aims to treat vulvar cancer by removing the cancerous tissue and nearby lymph nodes to prevent the spread of the disease. The goal is to eliminate cancer while maintaining as much normal function and appearance as possible.

Indications

• Diagnosis of localized vulvar cancer
• Presence of malignant lesions on the vulva
• Biopsy indicating invasive cancer
• High-grade squamous intraepithelial lesions not responding to other treatments
• Patient is otherwise healthy enough to undergo surgery

Preparation

• Pre-operative fasting (typically 8-12 hours before surgery)
• Discontinuation of certain medications as advised by the physician
• Pre-surgical imaging and blood tests for assessment
• Possible bowel preparation as per surgeon's instructions
• Consent and pre-surgery counseling

Procedure Description

1. Anesthesia is administered (general or regional).
2. The patient is positioned and the surgical site is cleaned.
3. An incision is made on the vulva to remove cancerous tissue.
4. The surgeon removes part of the vulva.
5. Bilateral incisions on both groins are made to access and remove the inguinofemoral lymph nodes.
6. Tissues are sent for pathological examination.
7. Hemostasis is ensured and the incisions are closed with sutures.
8. The area is dressed and recovery is initiated.

Duration

The procedure typically takes 2-4 hours.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Surgeon specialized in gynecologic oncology
• Anesthesiologist
• Surgical nurses
• Pathologist for tissue examination

Risks and Complications

• Bleeding and infection
• Lymphedema (swelling due to lymph node removal)
• Wound healing issues
• Pain and discomfort
• Anesthesia-related risks
• Scarring and changes in vulvar sensation
• Complications related to lymphadenectomy such as seromas

Benefits

• Removal of cancerous tissue
• Decreased risk of cancer spread
• Potentially curative if cancer is localized
• Maintaining some normal vulvar appearance and function

Recovery

• Hospital stay for observation (typically a few days)
• Pain management with medications
• Instructions on wound care and hygiene
• Limited physical activity for several weeks
• Follow-up appointments for monitoring and additional treatments if necessary

Alternatives

• Radiation therapy: may be used alone or in combination but might not be as effective in localized cancer.
• Chemotherapy: typically reserved for advanced cases or when surgery is not possible.
• Conservative surgery: lesser extent procedures like local excision, depending on cancer stage.
• Palliative care: for patients not eligible for curative surgery.

Patient Experience

• Pain and discomfort are expected, managed with medication.
• Swelling and drainage from surgical sites.
• Supportive care for emotional and psychological impact.
• Gradual return to normal activities over several weeks.
• Long-term follow-up for cancer recurrence monitoring.