POSTOPERATIVE COMPLICATIONS IN PATIENTS RECEIVING SURAMIN THERAPY

Background. Suramin is an antiparasitic agent that is currently being evaluated for antineoplastic activity. Documented toxicities of surami n include adrenal and renal insufficiency, coagulation factor abnormal ities, immunosuppression, and polyneuropathy. These adverse effects ha ve potential for contributing to postoperative morbidity in surgical p atients. Because no experience with suramin has been reported in the s urgical literature, this 5-year retrospective review of postoperative complications in patients receiving suramin was performed. Methods. Fr om a review of 171 charts, 14 patients were identified who had undergo ne a major surgical procedure either while receiving intravenous suram in or within 1 year after its administration. Primary diagnoses includ ed prostate cancer (six), lymphoma (four), ovarian cancer (two), colon cancer (one), and glioblastoma (one). All patients received replaceme nt dose hydrocortisone at the initiation of suramin therapy and therea fter. Results. Eighteen major surgical procedures were performed with 18 complications occurring in five patients. The predominant complicat ions encountered were hemorrhage (five), impaired would healing (three ), and bowel dysmotility (two). A highly significant relationship exis ted between the incidence of complications and interval from completio n of suramin therapy to the time of operation (p < 0.0005), with 17 of the 18 morbidities occurring within the first month. The length of op eration (p < 0.05) and amount of blood transfused during the procedure were related to postoperative morbidity (p < 0.5). No other factors e valuated were correlated to complications. Conclusions. This experienc e suggests the avoidance of elective procedures during the first month after suramin therapy and a heightened awareness of the potential for bleeding and would healing problems in patients receiving suramin who do require an emergent procedure.