title: [Surgical treatment for malignancies in children--is prolonged bone marrow suppression an absolute contraindication for surgical procedures?].
abstract: OBJECTIVE
  To analyze the perioperative period in children who required surgery anticipated in the protocol and suffered from prolonged bone marrow suppression.
  
  
  METHODS
  The surgical treatment of 15 children with prolonged bone marrow suppression, resistant to GM-CSF for 5-15 weeks (M=10), was retrospectively analyzed. Criteria to submit a patient to the group were: neutropenia <1000/ml or/and thrombocytopenia <70,000/ml. Four had thrombocytopenia, 8 neutropenia and 3 cytopenia of both cell lines. Neutropenic patients were divided into two groups: severe neutropenia--<500/ml (2), and moderate--500-1000/ml (7). Children with thrombocytopenia were divided into two groups: with thrombocytes <30,000/ml (2) and between 30,000-70,000/ml (5).
  
  
  RESULTS
  Complications (pneumonia and sepsis) were noted in 2 out of 4 children with severe neutropenia, remaining patients had uncomplicated perioperative period. Patients with moderate neutropenia did not show any alarming signs after surgery. As a major haemorrhage we assumed loosing > 30 percent of circulating blood. This was observed only in 1 patient (with thrombocytes <30,000/ml). 13 patients were discharged from our Department between 3-10 days after surgery in good general condition. Two had to be treated for a longer time because of advanced cancers (18 and 21 days).
  
  
  CONCLUSIONS
  Neutropenia does not seem to be an absolute contraindication for surgical procedures needed in complex cure of malignancies. In our opinion thrombocyte level > 30,000/ml appears to be safe enough to conduct surgery.
authors.affiliation: Oddział Chirurgii Dzieciecej, Szpital im. T. Marciniaka, ul. Traugutta 116, 50-420 Wrocław, Poland. asiaptaszynska@vp.pl
authors.forename: Joanna
authors.initials: J
authors.lastname: Ptaszyńska
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Rapała
authors.forename: Piotr
authors.initials: P
authors.lastname: Miśkiewicz
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sokół
authors.forename: Jan
authors.initials: J
authors.lastname: Godziński
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001854:Bone Marrow Cells / Q000187:drug effects / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D000075202:Contraindications; D005260:Female; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D009369:Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D009503:Neutropenia / Q000139:chemically induced*; D019990:Perioperative Care; D011044:Poland; D012189:Retrospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced*; D016896:Treatment Outcome
chemical_list: D016178:Granulocyte-Macrophage Colony-Stimulating Factor