Intraoperative blood loss during surgical treatment of low-rectal cancer by abdominosacral resection is higher than during extra-levator abdominosacral amputation of the rectum

Objectives: To explore the clinical surgical methods for the treatment of tensile effusion in postoperative cavity after glioma resection. Methods: Clinical data of 26 cases of tensile effusion in postoperative cavity after glioma resection were analyzed retrospectively. All 26 patients underwent surgical treatment, including 16 cases who underwent puncture and drainage (P&D), and 10 cases who underwent craniotomy decompression (CD). Among the cases of P&D, postoperative cavity in 7 cases were punctured through the burr hole for creating the skull flap for intraoperative resection of glioma, and postoperative cavities in 9 cases were punctured through a burr hole for the dura mater suspended under the skull flap. Glasgow Coma Scale (GCS) was used to evaluate the consciousness status of the two groups of patients before and after surgery. Moreover, time of operation, intraoperative blood loss, postoperative hospital duration, and postoperative complications were also adopted for evaluation of the merits of the two methods for treatment of tensile effusion in postoperative cavity after glioma resection. Results: The consciousness of the patients in both groups improved within 24 hours after the operation, and there were no death cases. In the P&D group, the GCS score within 24 hours after surgery was (14.38±0.20), the time of operation time was (7.81±0.64) mins, intraoperative blood loss was (6.25±0.56) ml, and postoperative hospital duration was (6.69±0.54) days. There were 3 cases with postoperative complications (1 case of puncture tract hemorrhage, 1 case of subdural hematoma and 1 case of intracranial infection) in the P&D group. All of the puncture tract hemorrhage and subdural hematoma did not require surgical treatment, and the intracranial infection was cured after antibiotic treatment and lumbar puncture for cerebrospinal fluid replacement. In the CD group, the GCS score within 24 hours after surgery was (13.70±0.21), the time of operation was (124.10±8.96) mins, intraoperative blood loss was (260±30.55) ml, and postoperative hospital duration was (11.30±0.60) days. There were 2 cases with postoperative complications (both of them were with subdural hematoma), none of which required surgical treatment. The GCS score, time of operation, intraoperative blood loss and postoperative hospital duration in the P&D group were better than those in the CD group (P < 0.05). There was no significant difference in the incidence of postoperative complications between the two groups (P >0.05). Conclusion: The P&D and CD for tensile effusion in postoperative cavity after glioma resection can both achieve ideal results, but P&D in line with the concept of micro-invasive neurosurgery was better than CD in terms of postoperative GCS score within 24 hours, duration of operative, intraoperative blood loss, and postoperative hospital duration.

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Anesthesia for surgery in a patient with Knist's dysplasia for severe scoliotic deformity

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic642 ◽

2020 ◽

Vol 10 (3) ◽

pp. 299-308

Author(s):

Igor V. Smirnov ◽

Grigorij E. Rojtberg ◽

Leonid E. Tsypin ◽

Vladimir V. Lazarev

Keyword(s):

Surgical Treatment ◽

Tracheal Intubation ◽

Blood Loss ◽

Spinal Deformity ◽

Abdominal Cavity ◽

Sensorineural Deafness ◽

Intraoperative Blood Loss ◽

Airway Patency ◽

Scoliotic Deformity ◽

Kniest Dysplasia

Kniest dysplasia is a disease that is inherited in an autosomal dominant manner. It manifests itself as dwarfism, scoliotic deformity of the spine, impaired joint mobility, muscle weakness, visual impairment, and sensorineural deafness. As a result of disproportionate trunk shortening, lumbar hyperlordosis and kyphoscoliosis develop, leading to internal organs (respiratory, cardiovascular system) disorders, disability, and reduced life expectancy. A case of surgical treatment of a patient with Kniest dysplasia for severe kyphoscoliotic spinal deformity is described. Posterior corrective cross-rod transpediculocorporal screw spondylodesis T3-L5 with bone autoplasty was performed. While planning anesthesia, difficult tracheal intubation was evaluated on the LEMON scale of 7 points high-risk. While performing tracheal intubation, endoscopic techniques were used: videolaryngoscope, intubation bronchoscope, enabling success. Management of intraoperative blood loss was conducted by a complex of measures: laying the patient in the prone position with the release of the abdominal cavity, normothermia, intraoperative hemodilution of azlactone-balanced polyionic solutions to achieve the target hematocrit in the range of 24%26%, and controlled hypotension with blood pressure decreased by 30% from the original hardware blood reinfusion during surgery. Also, on the first postoperative day, fusing tranexamic acid, correcting anemia and deficiency of blood coagulation factors donor components contributed to the success. Discussion. When planning surgery and anesthesia, it is necessary to consider the risk of developing malignant hyperthermia, predicting difficult intubation, and complying with the algorithm to ensure airway patency and prevent massive intraoperative blood loss. With a comprehensive approach to patient management, it is possible to achieve rapid rehabilitation and discharge for outpatient treatment. Surgical treatment for rapidly progressing severe kyphoscoliathical spinal deformity can change the quality and duration of life in patients with Kniest syndrome.

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Update and Debate Issues in Surgical Treatment of Middle and Low Rectal Cancer

Journal of the Korean Society of Coloproctology ◽

10.3393/jksc.2012.28.5.230 ◽

2012 ◽

Vol 28 (5) ◽

pp. 230 ◽

Cited By ~ 7

Author(s):

Nam Kyu Kim ◽

Min Sung Kim ◽

Sami F. AL-Asari

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Low Rectal Cancer

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PRIMARY EXPERIENCE OF NATURAL ORIFICE SPECIMEN EXTRACTION SURGERY (NOSES) FOR RECTAL CANCER

Koloproktologia ◽

10.33878/2073-7556-2020-19-2-69-82 ◽

2020 ◽

Vol 19 (2) ◽

pp. 69-82

Author(s):

D. K. Puchkov ◽

D. A. Khubezov ◽

I. S. Ignatov ◽

A. Y. Ogoreltsev ◽

R. V. Lukanin ◽

...

Keyword(s):

Rectal Cancer ◽

Blood Loss ◽

Operation Time ◽

Rectal Cancer Surgery ◽

Intraoperative Blood Loss ◽

Natural Orifice ◽

Specimen Extraction ◽

Postoperative Rehabilitation ◽

Intraoperative Complication ◽

Natural Orifice Specimen Extraction

AIM: to demonstrate the first results of natural orifice specimen extraction surgery (NOSES) for rectal cancer.PATIENTS AND METHODS: in the period from June 2019 to October 2019 five NOSES for rectal cancer were performed in the hospital. The following factors were evaluated: age, gender, BMI, ASA, operation time, intraoperative blood loss, intraoperative and postoperative complications, duration of postoperative rehabilitation, need for narcotic analgesics.RESULTS: mean age of patients was 61.2 years. Mean BMI was 25.9 kg/m2 . Mean ASA score was 2. Mean operative time was 225 minutes. Mean intraoperative blood loss was 45 ml. One intraoperative complication occurred – defect of anastomosis in the point of crossing of 3 stapler sutures. One postoperative complication occurred – postoperative ileus. Narcotic analgesics were not used. Mean duration of postoperative stay was 9.8 days. The primary results demonstrate feasibility of NOSES for rectal cancer with adequate qualification of colorectal surgeon.CONCLUSION: NOSES is a promising technique for rectal cancer surgery. However, the further experience and randomized trials are required.

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Impact of Procedure Time of Preceding Endoscopic Submucosal Dissection on the Difficulty of Laparoscopic Rectal Surgery

10.21203/rs.3.rs-44867/v1 ◽

2020 ◽

Author(s):

Hiroaki Nozawa ◽

Kazushige Kawai ◽

Kazuhito Sasaki ◽

Shigenobu Emoto ◽

Koji Murono ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Blood Loss ◽

Operative Time ◽

Anal Verge ◽

Rectal Surgery ◽

Tumor Location ◽

Intraoperative Blood Loss ◽

Procedure Time ◽

Laparoscopic Rectal Surgery

Abstract Background Endoscopic treatment for gastrointestinal cancer can cause inflammation, edema, and fibrosis formation in the surrounding tissue. Recently, we reported that preceding endoscopic treatment increased the volume of intraoperative blood loss and slightly prolonged the operative time of laparoscopic surgery for rectal cancer. In this study, we addressed which factors, including endoscopic submucosal dissection (ESD)- related parameters, affect the difficulty of laparoscopic rectal surgery. Methods We retrospectively reviewed 24 consecutive patients who underwent ESD followed by laparoscopic surgery for rectal cancer in our hospital. Short-term surgical outcomes were evaluated by intraoperative blood loss and operative time for laparoscopic surgery. The correlations between the surgical outcomes and preoperative parameter were analyzed by scatter diagrams and multiple linear regression analyses. Results The patient cohort comprised 12 men and 12 women. The median distance between primary cancer and anal verge was 7 cm. The median procedure time of ESD was 120 minutes (21 available cases). The scatter diagram graph revealed a positive correlation between the ESD procedure time and estimated blood loss during rectal surgery (rs = 0.26). There was no association between the ESD procedure time and operative time for rectal surgery. Based on multiple linear regression analyses, the ESD procedure time (p = 0.007) and tumor location from the anal verge (p = 0.046) were independently predictive of intraoperative blood loss. On the other hand, only tumor location was found an independent predictor of surgical time (p = 0.014). Conclusions A long session of ESD for rectal cancer may make subsequent laparoscopic surgery difficult based on intraoperative blood loss.

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Surgical treatment of low rectal cancer: Current status and future prospects

World Chinese Journal of Digestology ◽

10.11569/wcjd.v24.i21.3238 ◽

2016 ◽

Vol 24 (21) ◽

pp. 3238

Author(s):

Dong Wei

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Low Rectal Cancer ◽

Current Status ◽

Future Prospects

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Intersphincteric Resection for Low Rectal Cancer – Case Report

Acta Medica Marisiensis ◽

10.1515/amma-2015-0118 ◽

2016 ◽

Vol 62 (1) ◽

pp. 142-145

Author(s):

Cristian Russu ◽

Călin Molnar ◽

Sanda Maria Copotoiu ◽

Claudiu Sărăcuț ◽

Mircea Gherghinescu ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Multimodality Treatment ◽

Functional Results ◽

Radical Resection ◽

Intersphincteric Resection ◽

Low Rectal Cancer ◽

Cancer Case ◽

One Year

Abstract Introduction: Surgical treatment for low rectal cancer represents a challenge: to perform a radical resection and to preserve the sphincter’s function. We report a case of intersphincteric resection in a combined multimodality treatment for low rectal cancer, with good oncologic and functional outcome. Case presentation: We report a case of a 73 years old woman admitted in April 2014 in surgery, for low rectal cancer. The diagnostic was established by colonoscopy and malignancy confirmed by biopsy. Complete imaging was done using computed tomography and magnetic resonance to establish the exact stage of the disease. The interdisciplinary individualized treatment began with radiotherapy (total dose of 50 Gy, administered in 25 fractions) followed by surgery after eight weeks. We performed intersphincteric rectal resection by a modified Schiessel technique. There were no postoperative complications and the oncologic and functional results were very good at one year follow up. Conclusions: Intersphincteric resection, in this selected case of low rectal cancer, represented an efficient surgical treatment, with good functional results and quality of life for the patient. A multidisciplinary team is an invaluable means of assessing and further managing the appropriate, tailored to the case, treatment in the aim of achieving best results.

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