CPT® Code 43121

Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty

The procedure described by CPT® Code 43121 involves a partial esophagectomy, specifically targeting the distal two-thirds of the esophagus. This surgical intervention is performed through a thoracotomy, which is an incision made in the chest wall to access the thoracic cavity. The procedure may also include a proximal gastrectomy, which is the surgical removal of the upper portion of the stomach, and a thoracic esophagogastrostomy, where the esophagus is surgically connected to the stomach. Additionally, a pyloroplasty, which is a surgical procedure to widen the opening of the pylorus (the outlet of the stomach), may be performed, although it is not mandatory. In this procedure, a right posterior thoracotomy is typically utilized, allowing the surgeon to access the esophagus while minimizing disruption to the surrounding structures. The operation begins with an incision through the skin and soft tissues, followed by retraction of the scapula to enter the thoracic cavity without damaging the pleura. The surgeon performs retropleural dissection to expose the esophagus, identifying critical anatomical structures such as the pneumogastric and recurrent nerves, the azygous vein, and the bronchial artery. The esophagus is then carefully dissected from surrounding tissues, and the stomach is mobilized by splitting the diaphragmatic hiatus. The esophagus is transected near the esophagogastric junction, and if necessary, a portion of the stomach may also be excised to ensure complete removal of any malignancy. Following the removal of the esophagus, a gastric tube is created from the stomach, and specific arteries are ligated and divided to facilitate the procedure. If a pyloroplasty is indicated, the pylorus is surgically modified to enhance the passage into the duodenum. The final steps involve mobilizing the gastric tube into the mediastinum and performing an anastomosis between the gastric tube and the remaining thoracic esophagus, ensuring continuity of the digestive tract.