58954 Bilateral salpingo-oophorectomy with omentectomy, total abdominal hysterectomy and radical dissection for debulking; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy

Name of the Procedure:

Bilateral Salpingo-Oophorectomy with Omentectomy, Total Abdominal Hysterectomy, and Radical Dissection for Debulking; with Pelvic Lymphadenectomy and Limited Para-Aortic Lymphadenectomy.

Summary

This extensive surgical procedure involves the removal of both ovaries and fallopian tubes (salpingo-oophorectomy), the uterus (total abdominal hysterectomy), and the fatty tissue covering the abdomen (omentumectomy). Additionally, it includes the removal of pelvic and certain para-aortic lymph nodes and radical dissection to reduce tumor burden (debulking).

Purpose

This procedure is primarily performed to treat advanced ovarian, fallopian tube, or uterine cancer. The goals are to remove as much of the tumor as possible, prevent the spread of cancer, and improve the effectiveness of other treatments like chemotherapy.

Indications

• Diagnosed advanced ovarian, fallopian tube, or uterine cancer
• Large tumors that require reduced tumor load for effective additional treatment
• Patients who are otherwise fit for major surgery

Preparation

• Patients may need to fast for several hours before the procedure.
• Important to stop certain medications as advised by the physician.

• Pre-operative diagnostic tests such as blood work, imaging studies, and sometimes an EKG.

  Procedure Description

  1. The patient is administered general anesthesia to ensure they are unconscious and pain-free.
  2. A long incision is made in the abdomen to access the pelvic and abdominal organs.
  3. Both ovaries and fallopian tubes are removed (bilateral salpingo-oophorectomy).
  4. The uterus is removed through a total abdominal hysterectomy.
  5. The omentum is excised (omentectomy).
  6. Lymph nodes in the pelvic region and limited para-aortic region are removed to check for cancer spread (lymphadenectomy).
  7. Additional radical dissection is performed to remove as much tumor mass as possible (debulking).
  8. The incision is closed using sutures or staples.

Duration

The procedure typically takes about 4 to 6 hours, depending on the extent of disease spread and complexity.

Setting

The procedure is performed in a hospital operating room setting, typically under general anesthesia.

Personnel

• Gynecologic oncologist or specialized surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Injury to surrounding organs such as the bladder or intestines
• Complications from anesthesia
• Lymphedema
• Long-term hormonal changes if ovaries are removed

Benefits

• Reduction of tumor burden, potentially improving survival rates
• Pain relief from pressure caused by large tumors
• Enhances effectiveness of subsequent chemotherapy or radiation therapy

Recovery

• Hospital stay ranging from 3-7 days post-surgery
• Pain management with medications
• Instructions for wound care and activity limitations
• Full recovery can take 4-6 weeks; some activities may be restricted during this time
• Follow-up appointments to monitor healing and discuss further treatments if necessary

Alternatives

• Less extensive surgery, if appropriate
• Chemotherapy or radiation as primary treatment, especially if surgery isn't viable
• Hormone therapy or targeted therapy, depending on the cancer type
• Each alternative has varying success rates and side effect profiles

Patient Experience

Patients can expect some discomfort and pain post-procedure, managed with pain relief measures. They may feel tired and have restrictions on activities while healing. Emotional support is also essential due to the significant physical and hormonal changes following the procedure.