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An Urban Experience
J. Kirpensteijn1
1Hills Pet Nutrition, GPVA, Topeka, USA
Jolle Kirpensteijn, DVM PhD, Diplomate ACVS & ECVS, Chief Professional Relations Officer Hill’s Pet Nutrition,*
Emergencies often occur because of an underlying oncologic problem and pose a challenge for the
medical and surgical oncologist. Many tumor related emergencies require immediate surgical intervention but are complicated by the debilitated state of the patient
or ethical concerns for the patient’s ultimate prognosis. The acute nature of the problem, the physical status of the animal, and the availability of alternative treatment determine the necessity of immediate surgery. A decision has to be made in which the progression of the disease, general health status of the animal, and experience of the clinician are of extreme importance. All these factors influence surgical morbidity and mortality, the extent
of surgery, postoperative management, and overall prognosis. Thus every oncologic emergency requires a thorough evaluation and individual therapeutic approach.
The surgeon often has a central role in the diagnosis, treatment, and aftercare of the cancer patient in an emergency situation. The first step in managing the emergency is to evaluate the patient’s pathophysiologic status and eliminate immediate threats to the patient’s life. The anamnesis should include previous oncologic diagnoses, procedures, and therapies. At the same time, a cursory physical examination will point out signs of life-threatening complications that should be dealt with immediately to stabilize the patient’s physical functions. After stabilization, a thorough physical examination is performed and a diagnostic and therapeutic plan is formulated. Further diagnostic steps include general tests (complete blood count, biochemistry and clotting profiles, and urinalysis) and cancer specific tests (fine needle aspiration, radiography, ultrasonography, CT-, and MRI scans).
The timing, selection, and purpose of surgical therapy varies with the type of cancer and the site of involvement. Timing depends on whether the emergency involves 1) a patient with stable vital functions and a problem requiring surgical correction, 2) a patient with compromised vital functions and a delayed threat to life, or 3) a patient
with an immediate threat to life requiring surgical correction. Immediate surgery is only necessary in life-threatening situations and should be accompanied by adequate supportive care. The goal of surgery may be complete excision of the tumor and cure, palliation, cytoreduction, or histologic confirmation of the tumor type. Regardless of resection type, surgery should resolve the emergency situation. Complete excision of the tumor is the hopeful goal of surgery. Palliative surgery must improve the patient’s quality of life, and perhaps prolong it. The aim of cytoreduction is to decrease tumor bulk to improve the efficacy of adjunctive treatment. Cytoreduction without adjunctive therapy is of no benefit to the patient.34,84 Biopsy specimens always should be examined to aid in evaluating the prognosis and further therapy.
Postoperative management includes monitoring the return of normal physiologic functions, evaluation
of wound healing, the use of adjunctive therapy,
and periodic assessment of tumor recurrence and metastasis. Intensive supportive therapy is often necessary after emergency surgery and may include intravenous administration of fluids, blood, or plasma, antibiotic therapy, and nutritional support.
The benefits of surgical intervention in cancer patients must be weighed against the risks of surgery. Operative morbidity and mortality depend on the basic disease process, the surgical procedure, anesthesia, and
the patient’s general status and ability to withstand operative trauma. In oncologic patients, the basic disease process and debilitated state of the patient are major determinants of operative morbidity and mortality. Surgery may alleviate clinical signs in an emergency situation but mortality rates can be high. Every emergency cancer patient should be evaluated individually and carefully, and the risks and benefits of therapy should be explained to the client.
Exploratory laparotomy
The ventral midline approach is the standard access route for almost all of the abdominal contents and should be referred to as celiotomy. A laparotomy strictly refers to flank incisions.
The aim is to incise through the linea alba and to avoid cutting into the rectus abdominal muscles. This is caudally more difficult than cranially, because the width of the linea decreases caudally. The falciform ligament is the first organ that is encountered. To improve the exposure of the abdomen this ligament is normally dissected
and ligated cranially. Insufficient ligation may lead to abdominal hemorrhage. The abdomen should always be explored in a standard manner to avoid skipping certain

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