Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy
CPT4 code
Name of the Procedure:
Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy Commonly known as Radical Vulvectomy with Groin Lymph Node Dissection
Summary
A radical vulvectomy is a surgical procedure that involves the complete removal of the vulva, including surrounding tissues. In addition, a unilateral inguinofemoral lymphadenectomy involves the removal of lymph nodes from one side of the groin. This procedure is typically performed to treat advanced vulvar cancer.
Purpose
The purpose of this procedure is to remove cancerous tissues and nearby lymph nodes to prevent the spread of vulvar cancer. The goals are to eliminate the cancer cells, reduce the risk of recurrence, and improve the patient's chances of long-term survival.
Indications
- Patients diagnosed with advanced vulvar cancer.
- Presence of large or invasive tumors in the vulvar region.
- Detection of cancer spread to one side of the inguinal (groin) lymph nodes.
Preparation
- Patients are usually instructed to fast for 8-12 hours before the surgery.
- They may need to stop taking certain medications, such as blood thinners, a few days prior.
- Pre-operative tests, such as blood work, imaging scans (e.g., CT scan or MRI), and possibly a biopsy, are required to evaluate the extent of the cancer.
Procedure Description
- General anesthesia is administered to ensure the patient is asleep and pain-free.
- A surgical incision is made to remove the entire vulva and possibly nearby affected tissues.
- A second incision is made in the groin area to access and remove lymph nodes on one side.
- The removed tissues and lymph nodes are sent to pathology for analysis.
- The surgical wounds are closed with sutures or staples, and dressings are applied to prevent infection.
Duration
The procedure typically takes between 3 to 5 hours, depending on the complexity and extent of the cancer.
Setting
Radical vulvectomy with unilateral inguinofemoral lymphadenectomy is performed in a hospital operating room.
Personnel
- A surgical team led by a gynecologic oncologist or a general surgeon specialized in cancer surgery.
- An anesthesiologist to manage anesthesia.
- Surgical nurses and possibly a surgical assistant or resident.
Risks and Complications
- Common risks: infection, bleeding, pain, and wound complications.
- Rare risks: blood clots, urinary or bowel dysfunction, lymphedema (swelling due to lymph fluid buildup), and sexual dysfunction.
- Complications are managed with medication, wound care, physical therapy, and additional interventions if necessary.
Benefits
- Removal of cancerous tissue and lymph nodes reduces the risk of cancer spread and recurrence.
- Enhanced chances of long-term survival and potential cure of vulvar cancer.
- Improved quality of life post-recovery by addressing the cancer effectively.
Recovery
- Pain management will be provided using medications.
- Hospital stay typically lasts several days.
- Instructions on wound care, activity restrictions, and signs of infection will be given.
- Expect a recovery time ranging from 6 to 8 weeks.
- Follow-up appointments are crucial for monitoring recovery and cancer recurrence.
Alternatives
- Radiation therapy: Effective but may not be sufficient for advanced cancers.
- Chemotherapy: Often used in combination with surgery or when surgery isn’t an option.
- Less radical surgery: May be viable for less advanced cases, preserving more tissue but carrying a higher risk of cancer recurrence.
Patient Experience
- Patients may experience significant discomfort and require strong pain relief post-surgery.
- Emotional support and counseling could be beneficial due to the nature of the procedure.
- Gradual return to normal activities with guidance from healthcare providers.
- Long-term follow-ups are essential for ongoing health and monitoring of any cancer recurrence.