Key result
In patients undergoing multimodality treatment for advanced rectal cancer, severe haemorrhage was significantly related to the development of adult respiratory distress syndrome (P < 0.0001).
Why the study?
What are the anaesthetic results and complications in patients with advanced rectal cancer undergoing multimodality treatment including intraoperative radiotherapy?
Observational (n=106)
What are the anaesthetic results and complications in patients with advanced rectal cancer undergoing multimodality treatment including intraoperative radiotherapy?
Anaesthetic complications during multimodality treatment for advanced rectal cancer can be minimized with adequate management, though severe haemorrhage remains a significant risk factor for ARDS.
Severe haemorrhage was associated with ARDS in multimodality rectal cancer therapy; leaves open whether haemorrhage control reduces incidence.
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.
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Mannaerts et al. (2002) conducted an observational in Locally advanced primary or locally recurrent rectal cancer (n=106). Multimodality treatment (surgery, external beam radiotherapy, intraoperative radiation therapy) under general and epidural anaesthesia was evaluated on Anaesthetic results and complications. In patients undergoing multimodality treatment for advanced rectal cancer, severe haemorrhage was significantly related to the development of adult respiratory distress syndrome (P < 0.0001).
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