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Features of sepsis development in operated oncologic patients
Last reviewed: 04.07.2025
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Causes of sepsis development in operated cancer patients
The development of sepsis in oncosurgical patients is based on severe secondary immunodeficiency. A decrease in the levels of IgM, IgG and IgA by 1.2-2.5 times, lymphopenia (less than 1.0x10 9 /l), a decrease in the phagocytic capacity of neutrophils (FI 5 min <0), low concentrations of proinflammatory cytokines (TNF, IL-1, IL-6) in the blood serum, as well as a decrease in the expression of HLA-DR on monocytes have been recorded. The level of lymphocytes decreases intraoperatively, due to lymph node dissection, since oncological operations are extended, with high traumatism and a large volume of surgical tissue injury (clinical picture).
The clinical picture of sepsis is characterized by a low level of total blood protein (35-45 g/l), including albumin (15-25 g/l), which is accompanied by a preload deficit, increased vascular permeability (lymphatic drainage dysfunction), low COP (14-17 mm Hg), hypercoagulation and thrombus formation in the deep veins of the lower extremities and pelvis, and stress ulcers in the gastrointestinal tract often develop.
- Early onset of sepsis (2-4 days after surgery) due to severe immunodeficiency.
- Difficulties in diagnosis arise due to the development of SIRS and an increase in the level of procalcitonin (>5 ng/ml) in the 1-3 days after surgery, in response to surgical tissue trauma.
- Predominance of gram-negative resistant flora as a causative agent.
- The development of the PON syndrome often occurs both during the development of the septic process and due to surgical intervention involving the relevant organs and systems.
- Most often, sepsis develops as a result of peritonitis (abdominal sepsis in general) and pneumonia.
Diagnostics
- Control of the source of infection and isolation of the pathogen from it.
- Monitoring of hemodynamics, including central hemodynamics (invasive and non-invasive methods).
- Biochemical and clinical blood analysis to determine the leukocyte count, coagulogram, acid-base balance, coronary artery disease (CABG), and procalcitonin levels.
- Urine analysis.
- X-ray diagnostics and CT.
- Dynamics of the condition (APACHE, MODS, SOFA scales).
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Treatment of sepsis in operated cancer patients
Intensive therapy for sepsis is aimed at sanitizing the source of infection and correcting the manifestations of SIRS and MOF.
- Hydroxyethyl starch solutions (30-40 ml/kg) and 20% albumin solution 5 ml/kg intravenously are prescribed; they allow the COP to be brought to 23-26 mm Hg and thus maintain an adequate preload level and avoid hyperhydration of the lungs. A combination of colloidal solutions, vasopressors, and hydrocortisone (in septic shock) is used.
- A combination of antibacterial drugs (protected cephalosporins III, cephalosporins IV, carbapenems) and immunoglobulin solution is administered intravenously. Due to such a combination, the pathogen is eliminated and the development of antibiotic resistance is avoided.
- Use of LMWH and proton pump inhibitors.
- Replacement of organ functions in case of multiple organ failure. The so-called protective strategy of mechanical ventilation (in case of ARDS development), HD or hemodiafiltration (in case of ARF development) is used.