Anaesthetic perioperative management of patients with pancreatic cancer

Abstract

Pancreatic cancer remains a significant and unresolved therapeutic challenge. Currently, the only curative treatment for pancreatic cancer is surgical resection. Pancreatic surgery represents a technically demanding major abdominal procedure that can occasionally lead to a number of pathophysiological alterations resulting in increased morbidity and mortality. Systemic, rather than surgical complications, cause the majority of deaths. Because patients are increasingly referred to surgery with at advanced ages and because pancreatic surgery is extremely complex, anaesthesiologists and surgeons play a crucial role in preoperative evaluations and diagnoses for surgical intervention. The anaesthetist plays a key role in perioperative management and can significantly influence patient outcome. To optimise overall care, patients should be appropriately referred to tertiary centres, where multidisciplinary teams (surgical, medical, radiation oncologists, gastroenterologists, interventional radiologists and anaesthetists) work together and where close cooperation between surgeons and anaesthesiologists promotes the safe performance of major gastrointestinal surgeries with acceptable morbidity and mortality rates. In this review, we sought to provide simple daily recommendations to the clinicians who manage pancreatic surgery patients to make their work easier and suggest a joint approach between surgeons and anaesthesiologists in daily decision making.

Keywords: Pancreatic cancer; Pancreatic surgery; Perioperative anaesthesia management

Core tip: Currently, the only curative treatment for pancreatic cancer is surgical resection. However, this type of surgery is still burdened by considerable morbidity due to its complexity and to the type of referred patients (elderly and with many co-morbidities). We believe that anaesthetic management with proper surgical approaches can play a key role in the outcome of the patient. Simple perioperative precautions in anaesthetic management (patient risk assessment, fluids management, prevention of surgical site infection, thromboprophylaxis, intraoperative ventilation, and intensive postoperative management) can help to ensure that these surgical operations are performed with reasonable assurance.