CPT® Code 51597

Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof

Pelvic exenteration is a complex surgical procedure primarily aimed at treating malignancies located in the bladder, prostate, or urethra that have metastasized to adjacent pelvic tissues or organs. This extensive operation involves the complete removal of the bladder and may also include the excision of reproductive organs, such as the uterus, ovaries, fallopian tubes, and cervix in females, or the prostate in males, depending on the extent of the cancer and previous surgical interventions. The procedure is characterized by its comprehensive approach to addressing cancer that has spread beyond its original site, necessitating the removal of not only the affected organs but also surrounding tissues that may harbor cancerous cells. During the surgery, the abdomen is opened to allow for thorough exploration of the pelvic cavity, including inspection of the liver, peritoneum, bowel, and lymph nodes. Biopsies may be taken to assess the extent of the disease. The surgical team carefully dissects and removes the involved organs while ensuring that any necessary urinary diversion is established, which may involve the transplantation of ureters. The procedure may also include the creation of a colostomy if the rectum and colon are resected. The reconstruction of the pelvic area is an essential component of the surgery, utilizing various techniques such as omental, myocutaneous, or muscle flaps to restore the anatomy and function of the pelvis post-exenteration. Overall, pelvic exenteration is a significant intervention that requires careful planning and execution to manage the complexities associated with advanced malignancies in the pelvic region.