Extreme blood loss in cancer surgery: is it a verdict to the patient or a challenge to the staff?

Background. The development of anesthesiology allows performing combined operations in patients with locally advanced malignant tumors. A logical companion of aggressive cancer surgery is a massive blood loss, which can be so pronounced that it poses a threat to the life of the patient. Objective. The presented experience is an example of transformation of a nearly fatal situation into a curable one and can be useful in choosing an active treatment strategy in most desperate situations. Methods. This research includes 25 patients with the blood loss of 20 liters or more during surgery. Results. The median ratio of infusion to blood loss was 133%, and the ratio of the infusion to all fluid losses amounted to 118%. In 100% of cases, catecholamines were used to support the blood circulation: one drug used in 12% of observations and two to five drugs used in 88% of observations. 2 patients died during the operation. 5 patients died in the early postoperative period from multiple organ failure. The cause of death of another 5 patients was septic complications before the 28th post-op day. Discussion. Performing operations accompanied by acute massive blood loss requires an effective anesthetic support. Conclusions. Enforcement of certain diagnostic and therapeutic conditions (stage construction of anesthesia, hemodynamic and laboratory monitoring, adequate venous access, rational infusion, timely use of catecholamines, using cell-saver device) in the majority of cases allows completing the operation with the surgical control of hemostasis and successfully enduring traumatic and complicated surgery in half of cases.

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Infusion-transfusion therapy in the treatment of acute massive surgical blood loss in cancer surgery

Тромбоз, гемостаз и реология ◽

10.25555/thr.2021.4.0995 ◽

2021 ◽

Author(s):

П.И. Феоктистов ◽

А.Р. Шин ◽

А.О. Приходченко ◽

П.В. Вяткин ◽

Е.Н. Феоктистова

Keyword(s):

Blood Loss ◽

Large Scale ◽

High Efficiency ◽

Malignant Tumors ◽

Locally Advanced ◽

Cancer Surgery ◽

Quantitative Composition ◽

Transfusion Therapy ◽

Circulating Blood Volume ◽

Somatic Status

Введение. Расширенные комбинированные вмешательства являются основным методом лечения пациентов с местнораспространенными солидными злокачественными опухолями. Основным следствием масштабной онкохирургии является риск развития острой массивной кровопотери (ОМОК). Цель исследования: оценка переносимости ОМОК у онкологических больных. Материалы и методы. В одноцентровое ретроспективное исследование с января 1999 г. по декабрь 2018 г. были включены 4236 больных, оперированных в радикальном объёме по поводу злокачественных опухолей различных локализаций, течение операции у которых осложнилось ОМОК. Критерием ОМОК являлась потеря ≥ 50% от расчётного объёма циркулирующей крови (ОЦКр) в течение 3 ч операции. Пациенты, вошедшие в исследование, были разделены на 4 группы в зависимости от объёма кровопотери: от 51 до 100%, от 101 до 200%, от 201 до 300% и свыше 300% ОЦКр. Результаты. Пациенты исследованных групп не различались ни по общим показателям, ни по исходному соматическому статусу. Про анализированы качественный и количественный состав инфузионно-трансфузионной терапии (ИТТ), показатели баланса жидкости интраоперационно, продолжительность пребывания пациентов в отделении реанимации и интенсивной терапии, летальность. Заключение. Соблюдение определенного протокола ИТТ при онкологических операциях, осложнённых ОМОК, является залогом успешного лечения и позволяет снизить интраоперационную летальность до 0,8% и госпитальную летальность до 6,45%. Метод аппаратной реинфузии аутоэритроцитов продемонстрировал высокую эффективность. Background. Cancer surgery remains the backbone of treatment approaches in patients with locally advanced solid malignancies. Risk of acute massive blood loss (AMBL) remains the main complication of such large-scale cancer surgery. Objectives: assessment of AMBL tolerance in cancer patients. Patients/Methods. A single- center retrospective study from January 1999 to December 2018 included 4,236 patients who underwent radical surgery for malignant tumors of various localizations, whose course of surgery was complicated with AMBL. The AMBL criterion was the loss of ≥ 50% of the calculated circulating blood volume (СBVс) within 3 hours of the operation. The patients included in the study were divided into 4 groups depending on the volume of blood loss: from 51 to 100%, from 101 to 200%, from 201 to 300% and over 300% of СBVс. Results. Patients of the studied groups did not differ either in general parameters or in baseline somatic status. The qualitative and quantitative composition of infusion-transfusion therapy (ITT), intraoperative fluid balance, patients stay in the intensive care unit, and mortality were analyzed. Conclusions. Compliance with a specific ITT protocol during cancer surgery complicated by AMBL is the key to successful treatment and allows to reduce intraoperative mortality to 0.8% and hospital mortality to 6.45%. The method of intraoperative red cell salvage and autologus transfusion has demonstrated high efficiency.

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Innovative Approach to Surgical Treatment for Locally Advanced Cancer of Paranasal Sinus and Nasal Cavity

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1393 ◽

2021 ◽

Vol 76 (3) ◽

pp. 317-323

Author(s):

Oleg I. Kit ◽

Igor V. Reshetov ◽

Marina A. Engibaryan

Keyword(s):

Surgical Treatment ◽

Blood Loss ◽

Nasal Cavity ◽

Paranasal Sinus ◽

Malignant Tumors ◽

Locally Advanced ◽

Arterial Embolization ◽

External Carotid Artery ◽

External Carotid ◽

Control Group

Background. Despite the rapid oncology development, the problem of surgical treatment for locally advanced tumors of the paranasal sinus and nasal cavity is still relevant. The search and development of ways to improve the surgical approach, including modern endovascular methods, appears necessary. Aims development and evaluation of the effectiveness of an innovative approach to the surgical treatment of malignant tumors of the nasal cavity and paranasal sinus with superselective intra-arterial embolization as a preparatory stage. Materials and methods. The study is based on the treatment outcomes of 52 patients with cancer of the nasal cavity and paranasal sinus. The main group included 21 patients receiving treatment with our developed approach including preoperative superselective intra-arterial embolization as a preparatory stage for surgical treatment. The control group included 31 patients receiving standard surgical treatment with traditional ligation of the external carotid artery at the first stage. Estimation of the amount of intraoperative blood loss with gravimetric analysis was considered the primary endpoint of the study. Post-embolization syndrome manifestations were analyzed by evaluating the pain intensity with a visual analogue scale and thermometry. Results. Intraoperative blood loss in patients of the main group varied from 100 to 400 ml, being on average 231.9100.58 ml. In the control group, the blood loss varied from 300 ml to 1000 ml, on average 630.97190.23. The data analysis proved demonstratively the effectiveness of the developed approach to surgical treatment of locally advanced tumors of the nasal cavity and paranasal sinus, since it statistically significantly reduced the amount of intoperative blood loss (p 0.005). Conclusions. Our developed approach to the treatment for malignant tumors of the paranasal sinus and nasal cavity optimized the results of surgical treatment and statistically significantly reduced the amount of intoperative blood loss, compared to the traditional ligation of the external carotid artery, from 630.97190.23 to 231.9100.58 ml (p 0.005), with minimal manifestations of post-embolization syndrome.

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Immediate results of combined and multivisceral resections for rectal cancer

Siberian Journal of Oncology ◽

10.21294/1814-4861-2018-17-6-41-48 ◽

2019 ◽

Vol 17 (6) ◽

pp. 41-48

Author(s):

S. G. Afanasyev ◽

A. Yu. Dobrodeev ◽

I. B. Khadagaev ◽

S. A. Fursov ◽

E. A. Usynin ◽

...

Keyword(s):

Rectal Cancer ◽

Malignant Tumors ◽

Locally Advanced ◽

Survival Rates ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Early Postoperative Period ◽

Long Term Outcomes ◽

Multiple Primary

Background.Currently, the indications for multivisceral pelvic resections have increased dramatically. However, short-and long-term outcomes after these resections for locally advanced rectal cancer remain a subject of debate.The purposeof the study was to evaluate short-term surgical and oncological outcomes after multivisceral pelvic resections in patients with locally advanced rectal cancer.Material and methods. We analyzed surgical outcomes in 32 patients (13 men and 19 women) aged 44-69 years, with locally advanced rectal cancer, who were treated between 2010 and 2016. Of the 32 patients, 28 (87.5 %) had rectal cancer with invasion into adjacent organs (posterior wall of the bladder - 13, uterus - 10, ureters - 5, prostate - 4, vagina - 3; simultaneous damage to more than 2 organs - 14, multiple primary malignant tumors: rectal cancer + bladder cancer - 2, rectal cancer + endometrial cancer - 1, rectal cancer + rectal GIST - 1.Results.Total pelvic evisceration was performed in 6 (18.8 %) cases, combined resection of the rectum and adjacent organs was performed in 26 (81.2 %). Urinary tract resection was performed in 24 (75.0 %) patients. Of these patients, 13 (40.6 %) had primary plasty of the bladder and/or ureters. Postoperative surgical complications were observed in 11 (34.4 %) patients, of whom 7 (21.8 %) patients needed re-surgery. In 1 patient (3.1 %), who died in the early postoperative period, the cause of death was thrombosis of the right iliac vessels with subsequent acute renal failure. For patients with locally advanced rectal cancer, long-term outcomes were as follows: the overall and recurrence-free 2-year survival rates were 75 % and 56.3 %, respectively. All patients with multiple primary malignant tumors were alive with no evidence of disease recurrence at a follow-up of >24 months.Conclusion.Multivisceral resection in patients with locally advanced rectal cancer is a complex surgical procedure requiring the multidisciplinary team of surgeons. Despite high operative morbidity, proper perioperative management of the patients helps to achieve satisfactory immediate treatment outcomes. Long-term outcomes allowed us to consider such resections as a method of choice for locally advanced and multiple primary rectal cancers.

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Methods of reducing blood loss during reconstructive operations on the uterus

Journal of obstetrics and women s diseases ◽

10.17816/jowd88988 ◽

2003 ◽

Vol 52 (3) ◽

pp. 85-94

Author(s):

V. M. Orlov ◽

Y. V. Kovalyova

Keyword(s):

Blood Loss ◽

Postoperative Period ◽

Young Patients ◽

Surgical Techniques ◽

Early Postoperative Period ◽

Muscular Tissue ◽

Operative Blood Loss ◽

Massive Blood Loss ◽

Reconstructive Operations ◽

Tissue Defects

There can be no doubt about expediency of reconstructive operations on the uterus in young patients. These operations make it possible to preserve reproductive and menstrual function. However, such operations are accompanied by formation of extensive wound surfaces, considerable muscular tissue defects and characterized by high traumatism, quite often impossibility to ensure effective hemostasis and massive blood loss during operation. In this connection a number of complications during early postoperative period is higher than after hysterectomy. Taking into account the above, it is actual to use the surgical techniques which allow to reduce traumatism of operation and ensure effective hemostasis. In present review different methods used for ensuring hemostasis and reducing operative blood loss during reconstructive operations on the uterus are considered.

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Choice of an Infusion Agent for the Prevention of Multiple Organ Dysfunction in Acute Massive Blood Loss (Experimental Study)

General Reanimatology ◽

10.15360/1813-9779-2010-3-48 ◽

2010 ◽

Vol 6 (3) ◽

pp. 48

Author(s):

A. Yu. Yakovlev ◽

N. V Yemelyanov ◽

I. V. Mukhina ◽

A. V., Dvornikov ◽

L. B. Snopova ◽

...

Keyword(s):

Experimental Study ◽

Blood Loss ◽

Organ Dysfunction ◽

Multiple Organ ◽

Multiple Organ Dysfunction ◽

Massive Blood Loss

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DIFFERENTIATED PRESCRIPTION OF HEMOSTATIC DRUGS AT ACUTE MASSIVE BLOOD LOSS

Тромбоз, гемостаз и реология ◽

10.25555/thr.2017.2.0778 ◽

2017 ◽

Author(s):

М. Глотов ◽

А. Биркун ◽

Е. Рябикина ◽

С. Самарин ◽

М. Федосов

Keyword(s):

Blood Loss ◽

Central Place ◽

Fresh Frozen Plasma ◽

Multiple Organ ◽

Basic Drugs ◽

Clotting Factors ◽

Massive Blood Loss ◽

Fresh Frozen ◽

Dilutional Coagulopathy ◽

Frozen Plasma

Острая массивная кровопотеря (ОМК) остается тяжелым осложнением с высокой летальностью. Центральное место в танатогенезе этого состояния занимают нарушения коагуляции. ДВС-синдром и дилюционная коагулопатия часто осложняют ОМК и приводят к развитию полиорганной недостаточности. В статье рассмотрены современные подходы к назначению гемостатических средств при ОМК, принятые на территории РФ. Базисными препаратами для лечения ОМК являются свежезамороженная плазма, тромбоцитный концентрат, криопреципитат, отдельные факторы свертывания крови, препараты кальция и транексамовая кислота. Правильное использование этих средств предполагает адекватный мониторинг коагуляции. Acute massive blood loss (AMBL) remains to be a severe complication with high mortality rate. Coagulation disorders take central place in tanatogenesis of this condition. DIC-syndrome and dilutional coagulopathy are often complicated by AMBL and lead to development of multiple organ failure. This article presents current approaches that are accepted in Russian Federation of hemostatic drugs prescription in AMBL treatment. Fresh frozen plasma, platelet concentrate, cryoprecipitate, some clotting factors, calcium and tranexamic acid are basic drugs for AMBL treatment. Adequate coagulation monitoring is required for correct use of these drugs.

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Effect of age on outcome in patients with cerebral stroke

Medical alphabet ◽

10.33667/2078-5631-2020-2-41-45 ◽

2020 ◽

pp. 41-45

Author(s):

G. R. Kuchava ◽

E. V. Eliseev ◽

B. V. Silaev ◽

D. A. Doroshenko ◽

Yu. N. Fedulaev

Keyword(s):

Ischemic Stroke ◽

Neurological Deficit ◽

Neurological Status ◽

Statistical Correlation ◽

Multiple Organ ◽

The Body ◽

Social Adaptation ◽

Cerebral Stroke ◽

Septic Complications ◽

Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

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Thromboembolism in Patients With Advanced Gastroesophageal Cancer Treated With Anthracycline, Platinum, and Fluoropyrimidine Combination Chemotherapy: A Report From the UK National Cancer Research Institute Upper Gastrointestinal Clinical Studies Group

Journal of Clinical Oncology ◽

10.1200/jco.2008.19.4274 ◽

2009 ◽

Vol 27 (23) ◽

pp. 3786-3793 ◽

Cited By ~ 122

Author(s):

Naureen Starling ◽

Sheela Rao ◽

David Cunningham ◽

Timothy Iveson ◽

Marianne Nicolson ◽

...

Keyword(s):

Combination Chemotherapy ◽

Treated Patient ◽

Controlled Trial ◽

Central Venous Access ◽

Locally Advanced ◽

Venous Access ◽

Gastroesophageal Cancer ◽

National Cancer Research Institute ◽

The Uk ◽

Venous Access Device

PurposeData concerning the prevalence of and outcomes related to thromboembolic events (TEs) in patients with advanced gastroesophageal cancer who are undergoing chemotherapy are limited.Patients and MethodsThis was a prospective, exploratory analysis of TEs in a randomized, controlled trial of 964 patients recruited between 2000 and 2005 and treated with epirubicin/platinum/fluoropyrimidine combination chemotherapy for advanced/locally advanced gastroesophageal cancer. Regimens were epirubicin (E), cisplatin (C), fluorouracil (F; ECF); E, C, capecitabine (X; ECX); E, F, oxaliplatin (O; EOF); and EOX. Continuously infused F was administered via a central venous access device (CVAD) with 1 mg of warfarin for thromboprophylaxis. The principal outcome was the incidence of TEs (venous and arterial) in the whole treated patient cohort, according to chemotherapy, associated with CVADs and TE-related prognoses.ResultsThe incidences of any, of venous, and of arterial TEs among 964 treated patients were 12.1% (95% CI, 10.7 to 14.3), 10.1% (95% CI, 8.3 to 12.3), and 2.2% (95% CI, 1.4 to 3.4) respectively. There were fewer TEs in the O compared with the cisplatin groups (EOF/EOX v ECF/ECX: 7.6% v 15.1%; P = .0003). C was identified as a risk factor for TE in multivariate analysis (hazard ratio [HR], 0.51; 95% CI, 0.34 to 0.76; P = .001). There was no difference in the incidence of TEs for the F group compared with the capecitabine groups. The incidence of CVAD-related thrombosis was 7.0% (ECF/EOF arms). Overall survival was worse for patients who experienced TEs versus no TEs (median survival, 7.4 v 10.5 months; HR, 0.8; 95% CI, 0.64 to 0.99; P = .043).ConclusionThis analysis has prospectively quantified the incidence/pattern of TEs among patients with advanced gastroesophageal cancer who were treated with four triplet regimens, has demonstrated a differential thrombogenic effect according to platinum use, and has noted a poorer outcome associated with TE during treatment. Chemotherapy-related TE should contribute to the risk/benefit assessment of treatment.

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