Surgical Oncology and Perioperative Care Flashcards

Prehabilitation in the preoperative period for cancer surgery focuses on which intervention?

Answer: Optimizing physical fitness, nutrition, and psychological readiness before surgery

Prehabilitation is a multimodal preoperative program including aerobic and resistance exercise, nutritional optimization (protein supplementation, addressing deficiencies), and anxiety management. It has been shown to reduce postoperative complications, shorten length of stay, and improve functional recovery particularly for major abdominal and thoracic cancer surgeries.

A patient undergoes abdominoperineal resection (APR) for rectal cancer and requires a permanent colostomy. Postoperative colostomy education should emphasize which priority?

Answer: Proper pouching system management, skin care, and expected output characteristics

Postoperative ostomy education is a critical nursing responsibility. Key teaching includes proper pouch application and changing (every 3–5 days or when leaking), peristomal skin assessment and protection, expected stool output, dietary modifications to manage odor/gas/consistency, and return to normal activities.

In breast-conserving surgery (lumpectomy) for breast cancer, which additional procedure is performed to assess locoregional lymph node involvement with minimal morbidity?

Answer: Sentinel lymph node biopsy (SLNB)

SLNB is the standard nodal staging procedure for clinically node-negative breast cancer patients undergoing lumpectomy. By mapping lymphatic drainage to identify the first (sentinel) node(s), SLNB accurately predicts axillary nodal status while avoiding the lymphedema risk of complete ALND.

Milking or stripping surgical drains placed after oncologic surgery is now generally discouraged because:

Answer: It creates excessive negative pressure that can damage healing tissue and increase drainage volume

Research has shown that aggressive milking/stripping of surgical drains creates excessive negative pressure (up to -300 mmHg) that can damage delicate healing tissue, disrupt lymphatic sealing, and paradoxically increase drainage volume. Current evidence-based guidelines recommend gentle stripping only to clear clots when drains are not functioning.

Which lab value change in the immediate postoperative period after major cancer surgery most warrants notification of the surgical team?

Answer: Serum lactate >2 mmol/L with tachycardia and hypotension

Elevated serum lactate (>2 mmol/L) combined with tachycardia and hypotension in the postoperative period suggests tissue hypoperfusion and may indicate hemorrhage, sepsis, anastomotic leak, or other major complications requiring immediate intervention. This constellation represents a surgical emergency.

Intraoperative blood salvage (cell saver) use is CONTRAINDICATED in which oncologic surgery scenario?

Answer: Surgery for active infection or bacterial contamination

Cell salvage (autologous intraoperative blood recycling) is contraindicated when there is bacterial contamination (bowel perforation, abscess) due to risk of systemic sepsis. Relative contraindication exists in oncologic surgery due to theoretical risk of tumor cell reinfusion, though leukocyte depletion filters are sometimes used.