CPT® Code 45126

Pelvic exenteration for colorectal malignancy, with proctectomy (with or without colostomy), with removal of bladder and ureteral transplantations, and/or hysterectomy, or cervicectomy, with or without removal of tube(s), with or without removal of ovary(s), or any combination thereof

The procedure described by CPT® Code 45126 is known as pelvic exenteration for colorectal malignancy, which is a complex surgical intervention aimed at treating bulky, locally advanced primary or recurrent colorectal cancer that has metastasized to adjacent organs. This extensive operation involves the removal of the entire large bowel, rectum, and bladder, along with the potential removal of reproductive organs such as the uterus, cervix, fallopian tubes, and ovaries in women, or the prostate in men. The procedure is indicated when cancer has spread significantly, necessitating a wide surgical approach to ensure complete excision of malignant tissues. The surgical technique involves a midline abdominal incision to provide wide exposure of the abdominal cavity, allowing the surgeon to assess the extent of cancer involvement in surrounding structures. The operation includes a series of meticulous steps, such as the transection of the inferior mesenteric artery, mobilization of the sigmoid colon, and dissection of the pelvic region, ultimately leading to the removal of all affected organs in a single en bloc procedure. The ureters are then transplanted to a segment of the isolated ileum, which is exteriorized to create an incontinent ileal conduit, or a colonic reservoir may be fashioned for a continent urinary conduit. This procedure is significant not only for its complexity but also for its potential to improve survival outcomes in patients with advanced colorectal malignancies.