Abstract
Postoperative morbidity and mortality are reported to be high in patients with polycythemia vera (PV). A case of successful gastrectomy in a 82-year-old man associated with PV is described. The patient has been placed on an alkilating agent (mitobronitol) since he was diagnosed as PV at a cerebral attack 11 years ago. In 1989 the patient was admitted to the hospital because of upper abdominal discomfort. Upper abdominal series revealed an advanced gastric cancer locating in the antral lesser curvature. Red blood cell count was 4, 010, 000/mm3, white blood cell count was 6200/mm3, platelet count being 668, 000/mm3. On May 15, 1990, total gastrectomy was carried out under general anesthesia. No ascites was observed. The gastric cancer was of P0H0S2N2 in Stage III. Ulinastatin 200, 000 units daily was started immediately after the operation. On the day of operation the platelet count increased to 732, 000/mm3 and activated coagulation time (ACT) was shortened to 46 seconds. Continuous IV infusion of heparin 400-600 units/h was given from the 2nd to 11 postoperative day to keep ACT at about 150 seconds. Mitobronitol regimen was resumed on 9th day when the patient was permitted to take orally. No postoperative hematological complications occurred, and the patient was discharged from the hospital on the 20th postoperative day. It is speculated that hematological care is mandatory to control not only the pre-disseminated intravascular coagulation-state of PV, but also the perioperative hypercoagulative state.
