Objective  To investigate the clinical value of abdominal aortic balloon occlusion using in pelvic cavity tumor surgery. We evaluated the safety and effectiveness by analyzing the intraoperative interruption time, blocking frequency, blood loss, preoperative and postoperative hemoglobin levels, and pH value, among other factors. The impact of blocking frequency and duration on managing blood loss were analyzed to provide base line data for the clinical use of this hemostasis technique.

  Methods  The study ran from March 2013 to November 2019, and it included patients with a pelvic or sacral tumor who underwent surgery with abdominal aortic balloon occlusion in Hubei Cancer Hospital. Their data was collected and they were subsequently assigned into two groups according to the blocking times (≤ 60 min or >60 min) and blocking frequency. These were Group A, with a blocking time ≤ 60 min and blocking once, and group B with a blocking time >60 min, and blocking 1 or more times. Group A had 21 patients and group B had 9 patients. Amongst them, 10 cases in group A and 4 cases in group B underwent preoperative percutaneous angiographic embolization due to large tumor size or abundant blood supply. The subsequent data of interruption time, blocking frequency, blood loss, hemoglobin and pH value before and after operation were statistically analyzed, and the effects that blocking time and frequency had on blood loss and hemoglobin were compared.

  Results  All the patients underwent whole tumor or block resection, and reconstruction. The reconstruction methods included 3D printed hemipelvic prosthesis replacement, common prosthesis or screw/rod system fixation. When comparing the figures, the maximum blocking frequency was 3 times and the longest cumulative blocking time was 140 min. The average blocking time was (57.3±26.88) min, and the operational blood loss volume ranged from 400 to 7, 500 mL. All the patients recovered smoothly after their respective operations. The blood loss, hemoglobin decrease and other indicators in patients with a blocking time of less than 60 minutes were significantly better than those with a blocking time over 60 minutes or multiple blockings (P < 0.05). The average bleeding volume of patients with blocking times over 60 minutes or who underwent multiple blockings was more than 1.5 times that of patients with blocking times under 60 minutes (P < 0.05).

  Conclusions  Abdominal aortic balloon occlusion is safe for use in pelvic cavity surgery. Closely controlling the blocking time and frequency, and keeping the cumulative blocking time within 60 min are important in reducing intraoperative bleeding and associated complications. We should also pay attention to thorough preoperative screening, hemostasis, and the monitoring and management of blood loss related indicators. The use of abdominal aortic balloon occlusion during pelvic surgery should become a widespread and popular option to help control blood loss.