Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling biopsy, with or without removal of tube(s), with or without removal of ovary(s)
CPT4 code
Name of the Procedure:
Radical Trachelectomy with Bilateral Total Pelvic Lymphadenectomy and Para-aortic Lymph Node Sampling Biopsy, with or without Removal of Tubes and/or Ovaries
Summary
Radical trachelectomy is a surgical procedure that involves the removal of the cervix, surrounding tissues, and the upper part of the vagina, while preserving the uterus. This is combined with a comprehensive removal of lymph nodes in the pelvic area and sampling of lymph nodes around the aorta. Sometimes, the fallopian tubes and ovaries may also be removed.
Purpose
This procedure is primarily indicated for early-stage cervical cancer, aiming to remove cancerous tissues while preserving fertility. The lymphadenectomy helps to ascertain whether cancer has spread to lymph nodes, which guides further treatment.
Indications
- Early-stage cervical cancer (typically Stage I)
- Desire to preserve fertility
- Absence of lymph node metastasis
- General good health to withstand surgery
Preparation
- Fasting for at least 8 hours before the procedure
- Adjustment or cessation of certain medications as advised
- Pre-operative imaging tests, blood work, and consultation with the surgical team
Procedure Description
- General anesthesia is administered.
- An incision is made in the abdomen (or the procedure may be done laparoscopically).
- The cervix, upper vagina, and surrounding tissues are carefully removed.
- Bilateral total pelvic lymphadenectomy is performed, excising lymph nodes on both sides of the pelvis.
- Para-aortic lymph nodes are sampled to check for cancer spread.
- Depending on the case, the fallopian tubes and/or ovaries might be removed.
- The uterus is reattached to the remaining portion of the vagina.
- The incision is closed and the patient is moved to recovery.
Duration
The procedure typically takes 3-5 hours.
Setting
This surgery is performed in a hospital, usually in an operating room equipped for complex oncological surgeries.
Personnel
- A gynecologic oncologist performs the surgery
- An anesthesiologist manages anesthesia
- Surgical nurses assist during the procedure
- Pathologists may be involved for immediate biopsy analysis
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs (bladder, intestines)
- Infertility
- Lymphedema (swelling due to lymph node removal)
- Adverse reaction to anesthesia
- Blood clots
Benefits
- Effective removal of cancerous tissue
- Potential preservation of fertility
- Accurate staging of cancer through lymph node analysis
- Lower risk of needing more aggressive treatments if cancer is caught early
Recovery
- Hospital stay of 3-7 days post-surgery
- Pain management with prescribed medications
- Limited physical activity for 6-8 weeks
- Follow-up appointments for stitch removal and monitoring
- Potential need for physical therapy to manage lymphedema
Alternatives
- Radical hysterectomy (complete removal of the uterus)
- Chemoradiation
- Targeted therapy, depending on the cancer stage and type
- Advantages of alternatives might include less invasive nature or different side effect profiles, but they may also mean loss of fertility or different effectiveness rates.
Patient Experience
- Expectation of moderate to severe discomfort initially, managed with pain relief measures
- Experience of static and functional limitations during the recovery period
- Emotional impact considering the nature of cancer treatment and fertility implications
- Support through counseling and oncology care teams
Patients are advised to discuss their specific case and concerns thoroughly with their healthcare team to ensure a comprehensive understanding of the procedure, recovery, and expectations.