title: [Perioperational management of gynecological cancer patients with severe internal medical complications: a serial of 37 clinical cases].
abstract: Objective:To evaluate the effectiveness and safety of perioperational management of gynecological cancer patients with severe internal medical complications.Methods:We collected 37 cases of gynecological cancer patients with severe internal medical complications who were hospitalized in Peking University First Hospital from Jan. 2010 to Nov. 2014. All of the cases were planned to move to ICU right after operation based on the preoperational assessment of anesthetist and physician. The median age was 69.4 years, and 25 cases (68%,25/37) of them were over 70 years old. The pathological types, preoperational complications, preoperational preparation, process of anesthesia and surgery, post-operational short-term morbidity were retrospectively analyzed.Results:(1) Pathological type: among 37 cases of gynecological cancer patients, 16 cases of endometrial cancer, 12 cases of ovarian cancer, 5 cases of vulvar cancer, 3 cases of uterine sarcoma and 1 case of fallopian cancer. (2) Preoperational complication: all the patients had more than 2 types of internal complications, 34 cases (92%, 34/37)of them had no less than 3 types of internal complications. The preoperational complications mainly included 25 cases of hypertension, 13 cases of coronary heart disease and 5 cases of arrhythmia, 5 cases of history of cerebral infarction or hemorrhage, 19 cases of diabetes and 1 case of obesity, 6 cases of allergic asthma and history of pulmonary embolism. (3) Preoperational preparation: medication were taken according to internal physicians to make blood pressure lower than 140/90 mmHg(1 mmHg=0.133 kPa), fasting blood glucose lower than 8.0 mmol/L, postprandial blood glucose lower than 10.0 mmol/L and cardiac function return to a generally normal status. (4) Process of anesthesia and surgery: 37 cases completed operation successfully after preoperational anesthetic assessment and internal medication. No perioperational death was observed. (5) Post-operational morbidity: 17 cases of post-operational short-term morbidity were observed before discharge, including 9 cases of poor wound healing, 5 cases of gastro-intestinal dysfunction and 3 cases of pulmonary infection. All of them were improved or cured.Conclusion:Surgery is safe and applicable to gynecological cancer patients with severe internal medical complications on the compressive management of anesthesia assessment, perioperational internal adjustment and post-operational multi-discipline treatment.
authors.affiliation: *Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing 100034, China.
authors.forename: J
authors.initials: J
authors.lastname: Hu
authors.forename: W Q
authors.initials: WQ
authors.lastname: Lyu
authors.forename: Y L
authors.initials: YL
authors.lastname: Guo
authors.forename: H W
authors.initials: HW
authors.lastname: Wen
authors.forename: H
authors.initials: H
authors.lastname: Qiao
authors.forename: Y
authors.initials: Y
authors.lastname: Qu
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000009:adverse effects* / Q000401:mortality; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005833:Genital Neoplasms, Female / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008875:Middle Aged; D019990:Perioperative Care; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D012189:Retrospective Studies