Perioperative Care of the Surgical Patient: Bone and Soft Tissue Tumors

Introduction

Orthopedic oncology is one of the newest subspecialties in orthopedics that specializes in the management of musculoskeletal tumors, which are slowly increasing globally. The great variability of complexity and duration of oncologic orthopedic surgeries is such that there is no guide that can universalize the management for all patients. Surgery can range from short duration with limited bleeding to more demanding procedures such as sacrectomies or hemipelvectomies that require more complex management. Many procedures often require significant neurovascular dissection, removal of bone and/or significant muscle, replacement of large segments of bone and adjacent joints that may also require significant cement boluses for fixation, and free and rotational flaps. A clear understanding of what surgery implies allows proper positioning, airway management, and postoperative planning. ^–

Patients undergoing surgery to remove bone tumors have frequently received diverse preoperative medical treatments such as chemotherapy, radiotherapy, or a combination. The possible side effects of these agents are diverse. For example, doxorubicin, which is commonly used in bone chemotherapy, can cause dilated cardiomyopathy and arrhythmias. Bleomycin can lead to pulmonary fibrosis, and vincristine can contribute to peripheral neuropathy. In addition, patients who have undergone chemotherapy or radiotherapy may have significant anemia and thrombocytopenia, which could require transfusions of red blood cells or platelets. Obtaining adequate intravenous (IV) access and invasive monitors in preparation for resuscitation with fluids and possible transfusions can be a secondary challenge in ongoing cancer treatments. If the possibility of large blood loss due to a highly vascularized tumor is expected, preoperative tumor embolization may be considered. ^,

Oncoanesthesia and Some of the Crucial Steps for Better Perioperative Outcomes