Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy (intra-abdominal, retroperitoneal tumors), with omentectomy, if performed; with pelvic lymphadenectomy and limited para-aortic lymphadenectomy
CPT4 code
Name of the Procedure:
Resection (tumor debulking) of recurrent ovarian, tubal, primary peritoneal, uterine malignancy with omentectomy, pelvic lymphadenectomy, and limited para-aortic lymphadenectomy.
Summary
This surgical procedure involves removing as much of the tumor mass as possible to manage cancers in the ovaries, fallopian tubes, peritoneum, or uterus. The surgery may also include removing part of the omentum (fatty layer in the abdomen) and lymph nodes in the pelvic and para-aortic areas to prevent further spread.
Purpose
The procedure targets the removal of malignancies within the abdominal and retroperitoneal areas to manage and potentially reduce cancer burden. The goal is to decrease tumor size, alleviate symptoms, and improve survival rates.
Indications
- Recurrent ovarian, tubal, primary peritoneal, or uterine cancer
- Evidence of tumor spread to the omentum or lymph nodes
- Symptoms such as pain, bloating, or bowel obstruction caused by tumor mass
Preparation
- Fasting for at least 8 hours before surgery
- Preoperative imaging (CT scans, MRIs) and blood tests
- Discontinuation of certain medications as advised by the doctor
- Preoperative consultation to discuss the patient's medical history and current medications
Procedure Description
- The patient is administered general anesthesia.
- An incision is made in the abdomen to access the tumor.
- The surgeon debulks the tumor, removing as much mass as safely possible.
- An omentectomy is performed if involved, where part of the omentum is excised.
- Pelvic lymph nodes are removed to check for the spread of malignancy.
- Limited para-aortic lymphadenectomy is conducted to remove lymph nodes around the aorta.
- The incision is closed, and the patient is moved to the recovery area.
Duration
The procedure typically takes 3 to 6 hours, depending on the extent of the tumor and necessary resections.
Setting
The surgery is performed in a hospital setting, specifically in a surgical suite.
Personnel
- Gynecologic oncologist or surgical oncologist
- Anesthesiologist
- Surgical nurses
- Scrub technician
Risks and Complications
- Infection
- Bleeding
- Injury to surrounding organs (intestine, bladder)
- Blood clots
- Anesthesia-related complications
- Postoperative adhesions causing bowel obstruction
Benefits
- Reduction in tumor-related symptoms
- Potential increase in survival time
- Improved quality of life
- Decreased tumor burden
Recovery
- Hospital stay of 3 to 7 days post-surgery
- Pain management with prescribed medications
- Gradual return to normal activities over 4 to 6 weeks
- Follow-up appointments for wound checks and further treatments
Alternatives
- Chemotherapy or radiotherapy
- Targeted therapy
- Hormonal therapy
- Palliative care
Pros and cons of these alternatives depend on cancer stage, location, and patient health status. Less invasive but might not be as effective for large tumors.
Patient Experience
- Will experience grogginess and pain after waking from anesthesia, managed by pain medications.
- Might have a sore throat if a breathing tube was used during surgery.
- Experience fatigue and limited mobility initially, gradually improving with time.
- Emotional support from the healthcare team is essential to cope with the stress of cancer treatment.