RESUMEN
Venous thromboembolism is a frequent complication of gynecologic cancer, and may be the first symptom of occult malignant disease. Although anticoagulation therapy remains the standard of care in patients presenting with acute venous thromboembolism, inferior vena cava filters are an important alternative when anticoagulants are contraindicated or ineffective. We report a case of a 69-year-old woman who presented with left leg swelling secondary to deep venous thrombosis before the diagnosis of ovarian cancer. The aim of this study is to review the respective literature and report our experience with inferior vena cava filter placement to prevent pulmonary embolism in gynecologic cancer patients.
Asunto(s)
Neoplasias Ováricas , Embolia Pulmonar/prevención & control , Filtros de Vena Cava , Tromboembolia Venosa/prevención & control , Trombosis de la Vena , Anciano , Femenino , Humanos , Neoplasias Ováricas/complicaciones , Neoplasias Ováricas/terapia , Servicios Preventivos de Salud/métodos , Embolia Pulmonar/etiología , Tromboembolia Venosa/etiología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/etiología , Trombosis de la Vena/fisiopatología , Trombosis de la Vena/terapiaRESUMEN
Radical cystectomy is associated with significant morbidity and mortality due to complex surgery and comorbidities associated with advanced age of patients. In contrast to the surgery, which is clearly the procedure of choice for patients with invasive bladder cancer, the opti- mal anesthesiologic method is still under debate. Therefore, we retrospectively analyzed 85 patients having undergone radical cystectomy at our institution, either under combined epidural-general anesthesia (CEGA) or opioid based general anesthesia (GA). The intraoperative blood loss was significantly lower in CEGA group (497.37 ± 354.13) than in GA group (742.31 ± 403.69; p = 0.006), due to induced hypotension. Consequently, blood transfusion requirements were lower in CEGA group (107.20 ± 263.92) than in GA group (388.18 ± 321.32; p = 0.001). The incidence of postoperative ileus was also lower in CEGA group (p = 0.024). There was no difference in analgesic efficacy, but a trend towards lower incidence of venous thrombosis and infection was noticed. The results of our study suggest that epidural anesthesia might have specific advantages in patients undergoing radical cystectomy.