Features of Intensive Therapy of Enteral Insufficiency Syndrome in Cancer Patients After Multiorgan Operations

Abstract

Purpose. To determine the features of intensive care of enteral insufficiency syndrome (EIS) in cancer patients after multiorgan surgery.
 Materials and methods. The work is based on the analysis of data from the literature and the survey of 36 cancer patients who underwent multiorgan thoracic, abdominal, retroperitoneal operative interventions. The severity of patients’ status was assessed using SOFA scale depending on the stage of ESI. The qualitative and quantitative composition of the bacterial flora of intestinal contents was studied.
 Results. The increase in number of advanced and multi-organ surgery in cancer treatment can be noted. Statistical data showed that in 2018–2019 operative interventions on the chest organs comprised 47 %, and on abdominal cavity — 51 %. Regardless of the localization of surgery on various anatomical and physiological sites, the enteral insufficiency manifests in 39 % of all surgical interventions. The mortality rate due to enteral insufficiency is about 46 %, and SPOI complications are noted in 78 % of cases. Compensated and subcompensated EI in the postoperative period occurs in 95 %. A new method of electrochemical detoxication using sodium hypochlorite was suggested for EI patients treatment in order to reduce the indices of their pathogenic gut microbocenosis.
 This method allowed to decrease the yield of E. сoli by 57,5 %, Enterococcus faecalis — by 72,3 % during the first day. At the end of study the yield of Staphilococcus xylosus dropped by 84,3 %, Candida lusitaniae and Candida spp. — by 98,3 %. Enterobacter aggomerans was reduced by 50,4 %, Staphilococcus haemolyticus and St. aureus — by 56,8 %.
 Conclusions. Treatment of patients with SEI allowed to decrease the rate of complications 1.4 times, the treatment time in intensive care departmet was shortened 1.7 times, treatment costs were reduced 2.4 times. Thus, it seems reasonable to pay more attention to the enteral insufficiency, particlualrly to disturbances of microbiocenosis as a marker of septic complications, in routine clinical practice.