Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis

TY - JOUR

T1 - Abdominal emergency surgery in patients with hematological malignancies: a retrospective single-center analysis

AU - von Kroge, Philipp H

AU - Duprée, Anna

AU - Mann, Oliver

AU - Izbicki, Jakob R

AU - Wagner, Jonas

AU - Ahmadi, Paymon

AU - Weidemann, Sören

AU - Adjallé, Raissa

AU - Kröger, Nicolaus

AU - Bokemeyer, Carsten

AU - Fiedler, Walter

AU - Modemann, Franziska

AU - Ghandili, Susanne

N1 - © 2023. The Author(s).

PY - 2023/2/6

Y1 - 2023/2/6

N2 - BACKGROUND: Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear.METHODS: We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame.RESULTS: A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%.CONCLUSION: In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.

AB - BACKGROUND: Hematologic patients requiring abdominal emergency surgery are considered to be a high-risk population based on disease- and treatment-related immunosuppression. However, the optimal surgical therapy and perioperative management of patients with abdominal emergency surgery in patients with coexisting hematological malignancies remain unclear.METHODS: We here report a single-center retrospective analysis aimed to investigate the impact of abdominal emergency surgery due to clinically suspected gastrointestinal perforation (group A), intestinal obstruction (group B), or acute cholecystitis (group C) on mortality and morbidity of patients with coexisting hematological malignancies. All patients included in this retrospective single-center study were identified by screening for the ICD 10 diagnostic codes for gastrointestinal perforation, intestinal obstruction, and ischemia and acute cholecystitis. In addition, a keyword search was performed in the database of all pathology reports in the given time frame.RESULTS: A total of 56 patients were included in this study. Gastrointestinal perforation and intestinal obstruction occurred in 26 and 13 patients, respectively. Of those, 21 patients received a primary gastrointestinal anastomosis, and anastomotic leakage (AL) occurred in 33.3% and resulted in an AL-related 30-day mortality rate of 80%. The only factor associated with higher rates of AL was sepsis before surgery. In patients with suspected acute cholecystitis, postoperative bleeding events requiring abdominal packing occurred in three patients and lead to overall perioperative morbidity of 17.6% and surgery-related 30-day mortality of 5.9%.CONCLUSION: In patients with known or suspected hematologic malignancies who require emergency abdominal surgery due to gastrointestinal perforation or intestinal obstruction, a temporary or permanent stoma might be preferred to a primary intestinal anastomosis.

KW - Humans

KW - Retrospective Studies

KW - Intestinal Obstruction/etiology

KW - Anastomosis, Surgical

KW - Anastomotic Leak/etiology

KW - Cholecystitis, Acute/etiology

U2 - 10.1186/s13017-023-00481-z

DO - 10.1186/s13017-023-00481-z

M3 - SCORING: Journal article

C2 - 36747231

VL - 18

SP - 12

JO - WORLD J EMERG SURG

JF - WORLD J EMERG SURG

SN - 1749-7922

IS - 1

ER -