CPT® Code 38564

The procedure described by CPT® Code 38564 refers to a limited lymphadenectomy performed for staging purposes, specifically targeting the retroperitoneal lymph nodes, which include the aortic and/or splenic nodes. This surgical intervention involves making an incision in the abdomen to access the pelvic and para-aortic lymph nodes. The primary goal of this procedure is to evaluate the presence of metastatic disease by removing and examining lymph nodes that may harbor cancerous cells. During the operation, careful attention is given to preserve critical anatomical structures, such as the genitofemoral nerve and the psoas muscle, while stripping fatty tissue from the common iliac vessels and along the internal and external iliac vessels. The procedure is methodically executed, beginning with the exploration and removal of pelvic lymph nodes, followed by the opening of the peritoneal cavity to assess the abdomen and pelvis for any signs of metastasis. The para-aortic lymph nodes are then exposed, and biopsies are taken for immediate analysis through frozen section pathology. This allows for real-time assessment of lymph node involvement, guiding the surgeon in determining the extent of the dissection required. The procedure can be approached either transabdominally or thoracoabdominally, typically starting on the side of the malignancy, and may involve sampling lymph nodes along the splenic artery if necessary. The careful dissection and sampling of lymph nodes are crucial for accurate staging and subsequent treatment planning.