CPT® Code 38562

The procedure described by CPT® Code 38562 refers to a limited lymphadenectomy performed for staging purposes, specifically targeting the pelvic and para-aortic lymph nodes. This surgical intervention involves making an incision in the abdomen to access and evaluate the lymph nodes, which are critical in determining the presence of metastatic disease. The procedure begins with an exploration of the pelvic lymph nodes, which are carefully excised while preserving important anatomical structures such as the genitofemoral nerve and the psoas muscle. The surgeon meticulously strips fatty tissue from the mid-portion of both common iliac vessels and along the internal and external iliac vessels, extending to the level of the circumflex iliac vein. During the operation, the iliac, hypogastric, and obturator lymph nodes are bilaterally removed. Following this, the peritoneal cavity is opened, allowing for a thorough exploration of the abdomen and pelvis to check for any signs of metastatic disease. The para-aortic lymph nodes are then exposed, and biopsies are taken for frozen section analysis. If any para-aortic lymph nodes are found to be involved, they are excised as well. In cases where retroperitoneal lymph node staging is necessary, as indicated by CPT® Code 38564, the procedure may be approached either transabdominally or thoracoabdominally, typically starting on the same side as the malignancy. The retroperitoneum is fully exposed, and the dissection of the aortic lymph nodes commences at the renal vessels, extending laterally to the ureters and inferiorly to the bifurcation of the inferior mesenteric artery. This dissection includes lymph nodes located between the aorta and the inferior vena cava, and may also involve sampling lymph nodes along the splenic artery. The frozen section analysis of all lymph node samples is crucial for determining the extent of lymph node involvement, allowing the surgical approach to be adjusted based on the findings. Depending on the level of involvement on the ipsilateral side, lymph nodes on the contralateral side may also be sampled and excised as necessary.