Perioperative Management of Patients with Bone Sarcomas

Abstract

Bone sarcomas are associated with a host of complex and challenging issues that make perioperative management markedly different from that of the general orthopedic patient. Preoperative assessment must address cancer treatment-related comorbidities and anticipate psychosocial needs arising from the sequelae of radical operations. Appropriate timing of surgery with respect to chemotherapy is crucial to avert complications such as infection, hemorrhage, and wound dehiscence. Intraoperatively, close communication is vital between the surgical and anesthesiology teams in order to prevent adverse events. Aggressive blood product and fluid resuscitation during surgery is essential for many procedures in orthopedic oncology, and this is best accomplished as a joint effort on the part of the anesthesiology and surgery teams. Postoperative management is challenging for bone sarcoma patients in a variety of ways. Postoperative pain can be difficult to control since the wound is often massive; moreover, patients may have problems with chronic skeletal pain, a high tolerance to narcotic medication, and chemotherapy-related neuropathic pain. Other postoperative concerns include proper wound care, prevention of venous thromboembolic disease, electrolyte balance, nutrition, and mobilization. Proper medical management during the perioperative period can contribute substantially to the success of the operation as well as the overall oncologic treatment of the patient.