Bloodless surgery and gynecological patients among Jehovahs Witnesses.

OBJECTIVE: The aim of this research is to present our experiences with the surgical treatment of gynecological patients among Jehovahs Witnesses. Moreover, the medical, moral, and ethical problems in this regard have been highlighted. METHODS: 75 Jehovahs Witnesses patients were operated on for various benign and malignant gynecological diseases between 2007 and 2018. All of these patients were operated on according to the rules of blood-sparing surgery. RESULTS: The operations were assessed according to the dia-gnosis, mode of surgery, estimated blood loss, and disease outcome. Excessive blood loss did not occur during any of these operations, and the estimated blood loss for the same procedure was 10 to 550 mL. CONCLUSION: Jehovahs Witnesses gynecological patients is a group of high-risk patients because they refuse to undergo blood transfusion. Nevertheless, the principles of blood-sparing surgery should be applied to not only Jehovahs Witnesses patients but also to all patients in general. Even if a blood transfusion is the last resort to solve issues pertaining to excessive blood loss during complicated operations, the said procedure always carries certain risks. Therefore, blood transfusion should be performed only on rare occasions. Jehovahs Witnesses patients categorically refuse blood transfusion even if it is the only way to save ones life. Even though the legislation of the Czech Republic deals with this problem, there are other moral and ethical aspects that need to be addressed in this regard.

Peritoneal Carcinomatosis from Ovarian Cancer - Current Clinical Impact of Cytoreductive Surgery and Intraperitoneal Hyperthermic Chemotherapy.

Epithelial ovarian cancer is one of the most common causes of cancer-related death in women. More than half of patients are diagnosed at an advanced stage, usually due to locoregional spread of peritoneal carcinomatosis. A combination of systemic chemotherapy and cytoreductive surgery has been the standard treatment since the mid-1990s. However, conventional chemotherapy is poorly delivered to the peritoneum due to the plasma-peritoneal barrier. Intraperitoneal chemotherapy can improve survival by eliminating residual microscopic disease. A combination of hyperthermic intravenous and intraperitoneal chemotherapy may reduce plasma toxicity and increase therapeutic effectiveness. Several experts are investigating the effectiveness of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for both primary and recurrent ovarian cancer worldwide. Recent randomized studies indicate that this method prolongs overall patient survival and the disease-free interval. This approach is not yet part of standard guidelines and is the subject of several other clinical trials. However, indications should be considered in women with significant residual disease after neoadjuvant chemotherapy because these patients can benefit from comprehensive surgical resection in combination with hyperthermic intraperitoneal chemotherapy to prevent locoregional relapses.