58952 Resection (initial) of ovarian, tubal or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors)

Name of the Procedure:

Resection (initial) of ovarian, tubal, or primary peritoneal malignancy with bilateral salpingo-oophorectomy and omentectomy; with radical dissection for debulking (i.e., radical excision or destruction, intra-abdominal or retroperitoneal tumors)

Summary

The procedure involves surgically removing ovarian, tubal, or peritoneal cancer that has spread within the abdomen or pelvis. It includes the removal of both ovaries and fallopian tubes, the omentum (a layer of fatty tissue in the abdomen), and any visible tumor masses to reduce the amount of cancer present.

Purpose

This procedure addresses advanced-stage ovarian, tubal, or primary peritoneal cancer. The goal is to remove as much of the tumor as possible (debulking) to improve the effectiveness of other treatments like chemotherapy, alleviate symptoms, and potentially extend life.

Indications

• Diagnosed ovarian, tubal, or primary peritoneal malignancy.
• Advanced-stage cancer where significant tumor masses are present in the abdomen or pelvis.
• To improve prognosis by reducing tumor load.

Preparation

• Fasting for at least 8 hours before surgery.
• Medication adjustments, as advised by the doctor.
• Preoperative assessments such as blood tests, imaging studies (e.g., CT scans), and consultations with the surgical and anesthesia team.

Procedure Description

1. General anesthesia is administered to ensure the patient is asleep and pain-free.
2. An incision is made in the abdomen to access the pelvic organs.
3. Both ovaries, fallopian tubes, and the omentum are surgically removed.
4. Any visible tumors within the abdomen or retroperitoneal area are extensively excised or destroyed.
5. The surgical site is thoroughly inspected, and any additional tumor tissue is removed to achieve maximal debulking.
6. The incision is closed with sutures or staples.

Duration

The procedure typically takes between 3 to 5 hours, depending on the extent of the tumor spread.

Setting

The procedure is performed in a hospital operating room.

Personnel

• Lead surgeon (gynecologic oncologist)
• Surgical assistants
• Anesthesiologist
• Operating room nurses
• Scrub technicians

Risks and Complications

• Common risks: bleeding, infection, blood clots, pain, and delayed recovery of bowel function.
• Rare risks: injury to nearby organs (e.g., bladder, intestines), need for additional surgeries, or prolonged hospitalization.

Benefits

• Significant reduction of tumor burden.
• Improved effectiveness of subsequent treatments like chemotherapy.
• Potential prolongation of life and symptom relief.

Recovery

• Hospital stay of 5-7 days for monitoring and initial recovery.
• Pain management with medications.
• Instructions on wound care and activity restrictions.
• Follow-up appointments for monitoring recovery and planning further treatment.
• Full recovery may take 6-8 weeks, with gradual resumption of normal activities.

Alternatives

• Chemotherapy or targeted therapy alone, which might not be as effective without surgical debulking.
• Less extensive surgery, which may not remove as much tumor tissue.
• Hormonal therapy or clinical trials, depending on the specific cancer type and stage.

Patient Experience

• During: The patient is under general anesthesia and will not feel or remember the procedure.
• After: Postoperative pain managed with medications, potential discomfort from the incision, and gradual recovery of bowel function. Close monitoring for complications and support from the healthcare team to ensure a smooth recovery process.