Perioperative Management of the Oncologic Patient Undergoing Gastrointestinal Surgery

  • Bobby Bellard
  • Jasmin Eapen
  • Suma Joseph
  • Maxy Mathew
Reference work entry


Although the incidence of colon cancer has reduced over the past four decades due to the use of effective early detection colon cancer screening systems, colorectal cancer continues to be the third most diagnosed cancer in the United States (Hall and Ruutiainen, Sur Oncol Clin N Am 27:289–302, 2018). If colorectal cancer is limited to the colon or rectum only, colon resection or lower abdominal peritoneal resection surgery leads a high success rate of curing cancer. However, if metastasis occurs to other pelvic organs, then a pelvic exenteration surgery is the most opted route to remove the cancer. The following section will provide a brief overview of the background and management of patients undergoing three major gastrointestinal (GI) surgeries, specifically pelvic exenteration, colon resection, and lower abdominal peritoneal resection.


Colorectal cancer Colon cancer Metastasis Colon resection Pelvic exenteration Lower abdominal peritoneal resection Postoperative ICU management 


  1. 1.
    Ahn BK, Lee KH. Single-dose antibiotic prophylaxis is effective enough in colorectal surgery: antibiotic prophylaxis in colorectal surgery. ANZ J Surg. 2013;83(9):641–5.CrossRefGoogle Scholar
  2. 2.
    AlBalawi Z, Gramlich L, Nelson G, Senior P, Youngson E, McAlister FA. The impact of the implementation of the enhanced recovery after surgery (ERAS®) program in an entire health system: a natural experiment in Alberta, Canada. World J Surg. 2018;42(9):2691–700.CrossRefGoogle Scholar
  3. 3.
    Babcock BD, Aljehani MA, Jabo B, Choi AH, Morgan JW, Selleck MJ, Luca F, Raskin E, Reeves ME, Garberoglio CA, Lum SS, Senthil M. High-risk stage II colon cancer: not all risks are created equal. Ann Surg Oncol. 2018;25(7):1980–5.CrossRefGoogle Scholar
  4. 4.
    Baldini G, Fawcett WJ. Anesthesia for colorectal surgery. Anesthesiol Clin. 2015;33(1):93–123.CrossRefGoogle Scholar
  5. 5.
    Bogani G, Signorelli M, Ditto A, Martinelli F, Casarin J, Mosca L, Leone Roberti Maggiore U, Chiappa V, Lorusso D, Raspagliesi F. Factors predictive of 90-day morbidity, readmission, and costs in patients undergoing pelvic exenteration. Int J Gynecol Cancer. 2018;28(5):975–82.CrossRefGoogle Scholar
  6. 6.
    Bos MM, Bakhshi-Raiez F, Dekker JW, de Keizer NF, de Jonge E. Outcomes of intensive care unit admissions after elective cancer surgery. Eur J Surg Oncol. 2013;39(6):584–92.CrossRefGoogle Scholar
  7. 7.
    Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490–502.CrossRefGoogle Scholar
  8. 8.
    Wright DB, Koh CE, Solomon MJ. Systematic review of the feasibility of laparoscopic reoperation for early postoperative complications following colorectal surgery. Br J Surg. 2017;104(4):337–46.CrossRefGoogle Scholar
  9. 9.
    Guo Y, Chang E, Bozkurt M, Park M, Liu D, Fu JB. Factors affecting hospital length of stay following pelvic exenteration surgery. J Surg Oncol. 2018;117:529–34. Scholar
  10. 10.
    Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, McNaught CE, MacFie J, Liberman AS, Soop M, Hill A, Kennedy RH, Lobo DN, Fearon K, Ljungqvist O, Enhanced Recovery After Surgery (ERAS) Society, for Perioperative Care, European Society for Clinical Nutrition and Metabolism (ESPEN). Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) society recommendations. World J Surg. 2013;37(2):259–84.CrossRefGoogle Scholar
  11. 11.
    Hall NC, Ruutiainen AT. Colorectal cancer. Surg Oncol Clin N Am. 2018;27(2):289–302.CrossRefGoogle Scholar
  12. 12.
    Hanna MH, Vinci A, Pigazzi A. Diverting ileostomy in colorectal surgery: when is it necessary? Langenbeck’s Arch Surg. 2015;400(2):145–52.CrossRefGoogle Scholar
  13. 13.
    Hartz A, He T, Ross JJ. Risk factors for colon cancer in 150,912 postmenopausal women. Cancer Causes Control. 2012;23(10):1599–605.CrossRefGoogle Scholar
  14. 14.
    Hawkins AT, Albutt K, Wise PE, Alavi K, Sudan R, Kaiser AM, Bordeianou L, Continuing Education Committee of the SSAT, on behalf of the Continuing Education Committee of the SSAT. Abdominoperineal resection for rectal cancer in the twenty-first century: indications, techniques, and outcomes. J Gastrointest Surg. 2018;22(8):1477–87.CrossRefGoogle Scholar
  15. 15.
    Johnson EE, Heise CP. Low anterior resection and abdominoperineal resection. In: Chen H, editor. Illustrative handbook of general surgery. London: Springer; 2009.Google Scholar
  16. 16.
    Kannan U. Laparoscopic vs open partial colectomy in elderly patients: insights from the American College of Surgeons – National Surgical Quality Improvement Program database. World J Gastroenterol. 2015;21(45):12843.CrossRefGoogle Scholar
  17. 17.
    Levine JS, Ahnen DJ. Adenomatous polyps of the colon. N Engl J Med. 2006;355(24):2551–7.CrossRefGoogle Scholar
  18. 18.
    Martin LW, Sarosiek BM, Harrison MA, Hedrick T, Isbell JM, Krupnick AS, Lau CL, Mehaffey JH, Thiele RH, Walters DM, Blank RS. Implementing a thoracic enhanced recovery program: lessons learned in the first year. Ann Thorac Surg. 2018;105(6):1597–604.CrossRefGoogle Scholar
  19. 19.
    Martin TD, Lorenz T, Ferraro J, Chagin K, Lampman RM, Emery KL, Zurkan JE, Boyd JL, Montgomery K, Lang RE, Vandewarker JF, Cleary RK. Newly implemented enhanced recovery pathway positively impacts hospital length of stay. Surg Endosc. 2016;30(9):4019–28.CrossRefGoogle Scholar
  20. 20.
    Perry WB, Connaughton JC. Abdominoperineal resection: how is it done and what are the results? Clin Colon Rectal Surg. 2007;20(3):213–20.CrossRefGoogle Scholar
  21. 21.
    Puccini A, Berger MD, Naseem M, Tokunaga R, Battaglin F, Cao S, Hanna DL, McSkane M, Soni S, Zhang W, Lenz H. Colorectal cancer: epigenetic alterations and their clinical implications. BBA Rev Cancer. 2017;1868(2):439–48.Google Scholar
  22. 22.
    Shawki S, Ashburn J, Signs SA, Huang E. Colon cancer. Surg Oncol Clin N Am. 2018;27(2):269–87.CrossRefGoogle Scholar
  23. 23.
    Smith HJ, Boitano TKL, Rushton T, Johnston MC, Leath CA, Straughn JM. Impact of enhanced recovery after surgery (ERAS) protocol on postoperative pain control in chronic narcotic users. Gynecol Oncol. 2018;149:19.CrossRefGoogle Scholar
  24. 24.
    Spolverato G, Ejaz A, Azad N, Pawlik TM. Surgery for colorectal liver metastases: the evolution of determining prognosis. World J Gastrointest Oncol. 2013;5(12):207–21.CrossRefGoogle Scholar
  25. 25.
    Takii Y, Maruyama S, Nogami H. Can the prognosis of colorectal cancer be improved by surgery? World J Gastrointest Surg. 2016;8(8):574–7.CrossRefGoogle Scholar
  26. 26.
    Thiele RH, Raghunathan K, Brudney CS, Lobo DN, Martin D, Senagore A, Cannesson M, Gan TJ, Mythen MMG, Shaw AD, Miller TE, For the Perioperative Quality Initiative (POQI) I Workgroup. American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on perioperative fluid management within an enhanced recovery pathway for colorectal surgery. Perioper Med. 2016;5(1):1–15.CrossRefGoogle Scholar
  27. 27.
    Thiele RH, Rea KM, Turrentine FE, Friel CM, Hassinger TE, Goudreau BJ, Umapathi BA, Kron IL, Sawyer RG, Hedrick TL, McMurry TL. Standardization of care: impact of an enhanced recovery protocol on length of stay, complications, and direct costs after colorectal surgery. J Am Coll Surg. 2015;220(4):430–43.CrossRefGoogle Scholar
  28. 28.
    Yasukawa D, Hori T, Kadokawa Y, Kato S, Aisu Y, Hasegawa S. Trans-perineal minimally invasive surgery during laparoscopic abdominoperineal resection for low rectal cancer. Surg Endosc. 2018;33(2):437–447.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Bobby Bellard
    • 1
  • Jasmin Eapen
    • 1
  • Suma Joseph
    • 1
  • Maxy Mathew
    • 1
  1. 1.Department of Anesthesiology and Perioperative Medicine, Division of Anesthesiology and Critical CareThe University of Texas MD Anderson Cancer CenterHoustonUSA

Section editors and affiliations

  • Garry Brydges
    • 1
  1. 1.Department of Anesthesiology Division of Anesthesia, Critical Care and Pain MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

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