The current situation caused by the COVID-19 pandemic makes it difficult to provide specialized care to surgical patients. The timeliness and completeness of surgery is known to directly affect treatment outcomes and disease prognosis.The increased risk of morbidity and mortality from COVID-19 in patients with surgical pathology is also worth noting. In the conditions of anti-epidemic regime, careful planning of additional examination and treatment are further complicated by the burden on diagnostic and medical institutions, the need to pass tests for SARS-CoV2 at the prehospital stage, certain organizational anti-epidemic restrictions.
The University Clinic of Odessa National Medical University has focused on providing emergency surgical care to patients with more complex pathology that requires a multidisciplinary approach and high-tech equipment in the pandemic.
The case of patient L., 59, who was diagnosed with locally advanced ovarian cancer, subtotal carcinomatosis of the peritoneum of the pelvis, anterior abdominal wall, diaphragm, large cap, small, large intestine, and gallbladder is indicative; tumor conglomerate of ileocecal angle, lesion of common iliac lymph nodes on the left (PCI 18 points, PSS 0 points), T3sN2cM0, St.IIIC (FIGO). The course of the disease was complicated by the development of severe ascites-peritonitis, partial intestinal obstruction.
After careful additional examination and preoperative preparation, the operation was performed in the amount of: total median laparotomy, cytoreduction (CC-0): extirpation of the uterus with appendages, pelvic lymphadenectomy, omentectomy, right hemicolectomy, pre-ileotranslestic, cholecystoma, peritonectomy, electrovaporization of peritoneal tumor foci, intraperitoneal hyperthermic chemoperfusion (HIPEC).
The operation was performed by a multidisciplinary team consisting of the head of the Department of Obstetrics and Gynecology, MD. Ph.D., professor, oncogynecologist Gladchuk I.Z., head of the Department of Surgery №3, MD. Ph.D., professor, oncologist Tkachenko O.I.
Thanks to the joint efforts of the surgical, gynecological, anesthesiological teams, the patient satisfactorily endured a complex operation with multivisceral resections, intraoperative chemotherapy. The postoperative course was without complications. The patient is currently receiving the necessary systemic chemotherapy.
Timely surgery with primary optimal cytoreduction prevented the development of acute intestinal obstruction in the near future (1-3 days) and left a chance for further recovery.
Unfortunately, the number of such patients is constantly growing. Despite the challenges of modern realities, surgical care must be provided in a timely and complete manner.
The staff of the clinic has the opportunity to provide highly specialized medical care to patients in unique cases, and on such examples to train students of ONMedU, taking into account the achievements of modern medicine.