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18 - Surgical issues affecting patients with hemotologic malignancies

Published online by Cambridge University Press:  12 January 2010

By
Eve Rodler  and
Ted Wun
Edited by
Michael F. Lubin ,
Robert B. Smith ,
Thomas F. Dodson ,
Nathan O. Spell  and
H. Kenneth Walker
Eve Rodler
Affiliation:
Robert Wood Johnson School of Medicine, Camden, NJ
Ted Wun
Affiliation:
VA Northern California Health Care System, Sacramento, CA
Michael F. Lubin
Affiliation:
Emory University, Atlanta
Robert B. Smith
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Nathan O. Spell
Affiliation:
Emory University, Atlanta
H. Kenneth Walker
Affiliation:
Emory University, Atlanta
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Summary

Introduction

Hematologic malignancies are a heterogeneous group of malignant disorders that affect cells originating from bone marrow or lymphatic tissue. Patients with a diagnosis of leukemia, lymphoma, or multiple myeloma are susceptible to life-threatening crises such as leukostasis, disseminated intravascular coagulation, tumor lysis syndrome, infection, respiratory distress due to enlarging masses, and neutropenic enterocolitis (typhlitis). These serious problems may require surgical management or they may have an impact on the perioperative management of patients with hematologic malignancies. Surgery plays a role in the diagnosis of hematologic malignancies, including excisional lymph node biopsies, mediastinoscopy, or laparoscopy, in Hodgkin's and non-Hodgkin's lymphoma. Patients with hematologic malignancies may also present with common surgical problems, such as appendicitis, cholecystitis, bowel obstruction, ureteral obstruction, or bowel perforation due to infiltration of organs by malignant cells. There are also unique problems associated with the different types of hematologic malignancies which may require surgical intervention, such as: osteolytic bone lesions in multiple myeloma causing pathologic fractures; spinal cord compression due to multiple myeloma, lymphoma or solid tumors; hypersplenism in hairy cell leukemia; and neutropenic enterocolitis, perirectal abscesses, and locally invasive fungal infections during acute leukemia.

Indwelling venous access devices are often placed surgically for chronic central venous access to administer chemotherapy, long-term antibiotic therapy, blood and blood products, and total parenteral nutrition. Intraoperative complications related to the placement of central venous catheters are rare but include hemorrhage, pneumothorax, and hemothorax.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
 , pp. 230 - 247
Publisher: Cambridge University Press
Print publication year: 2006

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