AOCNP Surgical Oncology and Perioperative Care 5 — Questions and Answers
Question 1: A patient with stage III melanoma undergoes completion lymph node dissection after a positive sentinel node. Which postoperative complication occurs in up to 40% of patients following inguinal lymphadenectomy?
- Wound dehiscence requiring reoperation
- Lymphedema of the lower extremity (Correct answer)
- Deep vein thrombosis in the operative limb
- Seroma requiring multiple aspirations
Correct answer: Lymphedema of the lower extremity
Lymphedema is the most significant long-term complication after inguinal lymphadenectomy, affecting up to 40% of patients and requiring long-term compression therapy.
Question 2: During a laparoscopic colectomy, the anesthesia team notes end-tidal CO2 rising from 38 to 58 mmHg over 20 minutes. The MOST likely cause in this context is:
- Malignant hyperthermia triggered by volatile anesthetic
- CO2 absorption from pneumoperitoneum (Correct answer)
- Endobronchial intubation
- Pulmonary embolism reducing gas exchange
Correct answer: CO2 absorption from pneumoperitoneum
Hypercarbia during laparoscopic surgery is most commonly caused by CO2 absorption across the peritoneal membrane from pneumoperitoneum, typically managed by increasing minute ventilation.
Question 3: An oncology NP is reviewing a preoperative risk assessment. Which validated scoring tool is used to predict postoperative pulmonary complications in surgical oncology patients?
- POSSUM score
- ARISCAT score (Correct answer)
- Caprini score
- APACHE II score
Correct answer: ARISCAT score
The ARISCAT (Assess Respiratory Risk in Surgical Patients in Catalonia) score predicts postoperative pulmonary complications and guides risk stratification for surgical patients.
Question 4: A patient undergoes left pneumonectomy for central lung squamous cell carcinoma. On postoperative day 2, the patient develops sudden severe dyspnea and the trachea shifts to the right. Which complication has occurred?
- Bronchopleural fistula with tension pneumothorax on the right
- Postpneumonectomy pulmonary edema
- Mediastinal shift from the pneumonectomy space filling with fluid
- Cardiac herniation through the pericardial defect (Correct answer)
Correct answer: Cardiac herniation through the pericardial defect
Cardiac herniation is a rare but immediately life-threatening complication after pneumonectomy when the heart herniates through a pericardial defect, causing sudden cardiovascular collapse and mediastinal shift.
Question 5: In the context of surgical oncology, 'R0 resection' refers to:
- Removal of all visible tumor with histologically confirmed negative margins (Correct answer)
- Removal of all visible tumor with positive microscopic margins
- Debulking surgery leaving gross residual disease
- Emergency resection without frozen section margin analysis
Correct answer: Removal of all visible tumor with histologically confirmed negative margins
R0 resection indicates complete tumor removal with no residual microscopic disease at the surgical margins, representing the surgical goal for curative intent.
Question 6: A patient with advanced ovarian cancer undergoes interval debulking surgery after neoadjuvant chemotherapy. Which marker of optimal cytoreduction is associated with best overall survival outcomes?
- Residual disease <2 cm (R1 debulking)
- Residual disease <1 cm at any single site
- No visible residual disease (complete gross resection) (Correct answer)
- Residual disease limited to the pelvis only
Correct answer: No visible residual disease (complete gross resection)
Complete gross resection (no visible residual disease) at interval debulking surgery is consistently associated with the best overall survival in advanced ovarian cancer.
Question 7: Which preoperative condition in a surgical oncology patient requires MANDATORY cardiology clearance before elective major cancer surgery under general anesthesia, per ACC/AHA guidelines?
- Well-controlled hypertension on two medications
- Active unstable angina (Correct answer)
- History of coronary artery bypass grafting more than 5 years ago
- Asymptomatic mild aortic stenosis
Correct answer: Active unstable angina
Active cardiac conditions including unstable angina are major clinical predictors that require mandatory evaluation and stabilization before elective non-cardiac surgery per ACC/AHA guidelines.
AOCNP Surgical Oncology and Perioperative Care 5
A patient with stage III melanoma undergoes completion lymph node dissection after a positive sentinel node.
Which postoperative complication occurs in up to 40% of patients following inguinal lymphadenectomy?