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Anaesthesia for advanced rectal cancer patients treated with combined major resections and intraoperative radiotherapy

Published online by Cambridge University Press:  16 August 2006

G. H. H. Mannaerts
Affiliation:
Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
A. A. J. Van Zundert
Affiliation:
Catharina Hospital, Department of Anaesthesiology Eindhoven, The Netherlands
V. C. H. Meeusen
Affiliation:
Catharina Hospital, Department of Anaesthesiology Eindhoven, The Netherlands
H. Martijn
Affiliation:
Catharina Hospital, Department of Radiotherapy, Eindhoven, The Netherlands
H. J. T. Rutten
Affiliation:
Catharina Hospital, Department of Surgery, Eindhoven, The Netherlands
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Abstract

Background and objective: Multimodality treatment for patients with locally advanced primary or locally recurrent rectal cancer, including high-dose preoperative external beam radiotherapy, extensive surgery and intraoperative radiation therapy, decreases the local recurrence rates and improves survival. During this aggressive operation, the anaesthesiologist is faced with potential problems such as major transfusion requirements, hypothermia, intraoperative position changes, the need to transport the patient to the intraoperative radiation therapy applicator, and the risks associated with remote monitoring of the patient during the 10 min intraoperative radiation therapy application. The anaesthetic management and perioperative results were evaluated for the anaesthetic results and the complications.

Methods: One-hundred-and-six patients undergoing the multimodality treatment between February 1994 and March 2000 for locally advanced primary (n = 50) and locally recurrent rectal cancer (n = 56) were retrospectively evaluated for their anaesthetic results and complications.

Results: All patients were operated upon using a combination of general and epidural anaesthesia. The average duration of anaesthesia was 6 (range 3–10.5) h and the mean blood loss 3.6 (range 0.4–14) L. All patients recovered well from anaesthesia. Two patients (2%) died in the intensive care unit (34 and 48 days postoperatively) because of adult respiratory distress syndrome following postoperative haemorrhage. Severe haemorrhage during or after the operation was significantly related with the development of adult respiratory distress syndrome (P < 0.0001).

Conclusions: With adequate preoperative assessment and optimalization of the patient's condition, maintaining peroperative haemodynamic stability with the help of adequate remote monitoring, early and fast transfusion, and multidisciplinary communication, anaesthetic complications can be minimized.

Type
Original Article
Copyright
2002 European Society of Anaesthesiology

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