RISK MANAGEMENT OF COMPLICATIONS OF SURGICAL TREATMENT OF COLORECTAL CANCER BY CORRECTION OF THE HEMOSTASIS SYSTEM

Authors:

Abstract:

In 72 patients with verified colorectal cancer (T2-4N0-2M0-1), who were planned and performed surgical intervention in order to prevent complications, including thrombohemorrhagic complications, comorbid burden was studied according to the Charlson comorbidity index questionnaire and the results of study of hemostatic potential (low-frequency piezothromboelastography) after functional test with double local ischemia of the upper limb. The predicted relative risk of thrombohemorrhagic complications was high (relative risk THC=3.2; p=0.017). In the patients with III–IV stages of the disease, the results of low-frequency piezothromboelastography corresponded to the decompensated or depleted type of reaction of the hemostasis system (r=0.59; p=0.036). Depending on the disorders identified in the patients, the following were used: antiplatelet agents, direct anticoagulants, bioflavinoids, cofactors of the components of the coagulation system, antifibrinolytic drugs. The use of the developed prophylaxis regimens made it possible to reduce the incidence of postoperative complications, the total share of which was 8.4 %, including: pulmonary embolism occurred in 1.4 % of cases and hemorrhagic complications – in 2.8 %.

Keywords:

prognosis risk complications colorectal cancer surgical treatment low-frequency piezothromboelastography

References:

1. Hachaturova EA, Savushkin AV, Gubko AV Osobennosti antikoagulyantnoy terapii u bolnykh rakom tolstoy kishki v zavisimosti ot narusheniy gemostaza. Koloproktologiya. 2015; 52(2): 37–43. [in Russian]
2. Natsionalnyy kancer-reyestr Ukrayiny. Dostupno na: http://www.ncru.inf.ua/publications/ [in Ukrainian]
3. Sazonov AA Personifitsirovannyy podkhod k khirurgicheskomu lecheniyu rasprostranennykh form kolorektalnogo raka u patsientov pozhilogo I starcheskogo vozrasta, [dissetatsia]. SPb, 2020. 298 s [in Russian]
4. Tverdovskyy IV. Vykorystannya proby z podviynoyu lokalnoyu hipoksiyeyu verkhnyoyi kintsivky u khvorykh na obliteruyuchyy ateroskleroz sudyn nyzhnikh kintsivok. Meditsina neotlozhnykh sostoyanyi. 2019; 109(8). Dostupno na: http://www.mif-ua.com/archive/article/48723. [in Ukrainian]
5. Yunkerov VI, Grigorev SG, Rezvancev MV. Matematiko-statisticheskaya obrabotka dannykh meditsinskikh issledovaniy. Moskva: “Vmeda”. 2011. 318 s. [in Russian]
6. Ali F, Al-Kindi SG, Blank JJ, Peterson CY, Ludwig KA, Ridolfi TJElevated venous thromboembolism risk following colectomy for IBD is equal to those for Colorectal Cancer for ninety days after surgery. Dis Colon Rectum.2018 Mar; 61(3):375–381. doi: 10.1097/DCR.0000000000001036
7. Carioli G, Malvezzi M, Bertuccio P, Hashim D, Waxman S, Negri E, et al. Cancer mortality in the elderly in 11 countries worldwide, 1970–2015. Annals of Oncology. 2019;30, (8):1344–1355. doi: 10.1093/annonc/mdz178.
8. Kaida S, Miyake T, Murata S, Yamaguchi T, Tatsuta T, Murakami K, et al. A prospective multicenter observational study of venous thromboembolism after gastric cancer surgery (SHISA-1601). Eur Surg Res. 2021;62:10–17 https://doi.org/10.1159/000514309/
9. Lu X, Zeng W, Zhu L, Liu L, Du F, and Yang Q, Application of the Caprini risk assessment model for deep vein thrombosis among patients undergoing laparoscopic surgery for colorectal cancer. Medicine (Baltimore). 2021 Jan 29; 100(4): e24479. Published online 2021 Jan 29. doi: 10.1097/MD.0000000000024479
10. Nakagawa K, Watanabe J, Suwa Yu, Suzuki S, Ishibe A, Ota M, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients with colorectal cancer: Retrospective observational study. Ann Gastroenterol Surg. 2019 Jul; 3(4): 451–458. doi: 10.1002/ags3.12256.
11. Osaki T, Saito H, Fukumoto Y, Kono Y, Murakami Y, Shishido Y, et al. Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery. Surg Today. 2018 May; 48(5):525–33. doi: 10.1007/s00595-017-1617-4. Epub 2017 Dec 12.
12. Rasool S, Kadla SA, Rasool V, Ganai BA A comparative overview of general risk factors associated with the incidence of colorectal cancer. Tumor Biol. 2013; 34:2469–76. doi: 10.1007/s13277-013-0876-y
13. Suzuki S, Chino A, Kishihara T, Uragami N, Tamegai Yo, Suganuma T [et al.] Risk factors for bleeding after endoscopic submucosal dissection of colorectal neoplasms. World J Gastroenterol. 2014 Feb 21; 20(7): 1839–1845. Published online 2014 Feb 21. doi: 10.3748/wjg.v20.i7.1839.
14. Xynos E, Tekkis P, Gouvas N, Vini L, Chrysou E, Tzardi M [et all.] Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO). Ann Gastroenterol. 2016 Apr-Jun; 29(2): 103–126. doi: 10.20524/aog.2016.0003.

Publication:

«World of Medicine and Biology» Vol. 17 No. 77 (2021) , с. 21-27
УДК 616.348/352-006.6-089-06-048.78

DOI:

https://doi.org/10.26724/2079-8334-2021-3-77-21-27