Preoperative Evaluation and Medical Optimization of the Cancer Patient

Introduction

Although many of the goals of preoperative evaluation and optimization are the same for patients with and without cancer, cancer patients present a unique set of challenges that perioperative physicians must be familiar with. The overall goals of preoperative evaluation are to understand the whole patient, identify undiagnosed or undertreated conditions, and acknowledge patient- and procedure-related risk factors in order to prepare the patient optimally for surgery. A comprehensive preoperative evaluation lays the groundwork for high-quality care of the surgical patient. Additionally, a comprehensive preoperative evaluation of the cancer patient lends insight into potential risks and complications that may occur in the postoperative period.

History and Physical Examination

For all patients, the preoperative evaluation should involve information gathering through history taking, review of medical records, diagnostic testing, and a focused physical examination. All medications must be reviewed and confirmed with the patient. The history of each medical condition should be reviewed in detail to develop an understanding of the level of control of each and to determine if additional treatment or optimization is needed. The physical examination should be focused as to add insight into findings from the review of the history.

For cancer patients, it is especially important to take a detailed history that includes initial presenting symptoms and how the diagnosis of cancer was made. A thorough review for any history of cancer and prior cancer treatments should be conducted. As treatment of cancer is, more often than not, multi-disciplinary, it is of particular importance to note current treatment in the neoadjuvant period. Recent cancer treatment, including chemotherapy and radiation therapy, must also be reviewed as these may have systemic effects relevant to perioperative management (addressed elsewhere). It is important to note that recent imaging should be reviewed in order to understand the nature of any solid tumors and other organ involvement that may impact perioperative care (e.g., head or neck tumor compromising the airway). Care should be taken to ensure that the physical examination includes findings related to the area of tumor involvement, and these findings should be documented carefully (for example, hepatomegaly in liver cancer).