Surgical Oncology and Perioperative Care Flashcards

Which perioperative nursing assessment is most critical before major oncologic surgery involving general anesthesia?

Answer: Comprehensive assessment of functional status, nutritional state, and comorbidities

Preoperative assessment of functional status (ECOG/Karnofsky), nutritional status (weight loss, albumin/prealbumin), comorbidities, medication review, and psychosocial factors determines surgical risk, guides perioperative planning, and identifies need for prehabilitation to optimize outcomes.

A patient post-Whipple procedure (pancreaticoduodenectomy) on day 2 develops significant drainage from the drain with amylase level >3× the serum amylase. This indicates which complication?

Answer: Postoperative pancreatic fistula (POPF)

Postoperative pancreatic fistula is defined by drain amylase >3× the upper limit of normal serum amylase on or after postoperative day 3. It is one of the most common serious complications after Whipple procedure, graded A (biochemical leak) to C (severe, requiring reoperation).

Which complication is most commonly associated with total gastrectomy for gastric cancer and requires lifelong supplementation?

Answer: Vitamin B12 deficiency due to loss of intrinsic factor

The stomach produces intrinsic factor, essential for vitamin B12 absorption in the terminal ileum. Total gastrectomy eliminates intrinsic factor production, causing pernicious anemia. Patients require lifelong vitamin B12 supplementation, typically by intramuscular injection since oral absorption is absent without intrinsic factor.

Dump syndrome following gastric surgery or esophagectomy is characterized by which symptom cluster?

Answer: Nausea, diarrhea, diaphoresis, palpitations after eating (early) or hypoglycemia (late)

Dumping syndrome results from rapid gastric emptying of hyperosmolar contents into the small bowel. Early dumping (within 30 min) causes GI symptoms (nausea, cramping, diarrhea) and vasomotor symptoms (flushing, diaphoresis, tachycardia). Late dumping (1–3 h) causes reactive hypoglycemia. Management includes dietary modifications and small frequent meals.

Venous thromboembolism (VTE) prophylaxis in cancer surgery patients typically involves which combination?

Answer: Pharmacologic prophylaxis (LMWH) plus mechanical prophylaxis (sequential compression devices)

Cancer patients have 2–6× higher VTE risk than non-cancer surgical patients due to hypercoagulability. Combined mechanical (SCDs) and pharmacologic (LMWH/heparin) prophylaxis beginning perioperatively, with extended prophylaxis for 28 days post-discharge for high-risk abdominal/pelvic cancer surgery, is standard of care.

Which wound complication is most specifically associated with colorectal resection surgery and manifests as separation of abdominal fascial layers?

Answer: Wound dehiscence (fascial separation)

Wound dehiscence (separation of fascial wound layers) is a serious complication of abdominal surgery, more common in patients who are immunocompromised, malnourished, obese, or received preoperative radiation/steroids. It requires urgent surgical consultation and may progress to evisceration if full-thickness.