Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy in cancer patients

According to the Centers for Disease Control and Prevention (CDC), it is estimated that 89,000 women in the United States are diagnosed with a gynecologic cancer annually [1]. It is estimated that over a million new cases and half million deaths are due to gynecological cancers occurring annually worldwide (Minig et al., Front Oncol 5:308, 2016). These cancers include ovarian, uterine, fallopian tube, cervical, vulvar, and vaginal. Surgical management involves a combination of tumor cytoreduction, hysterectomy, bilateral or single salpingo-oophorectomy, cervical conization, vulvectomy, wide local excision, lymphadenectomy, omentectomy, pelvic exenteration, laser, and radiation treatment. Surgical techniques include an open abdomen, laparoscopic, and robotic laparoscopic approach. Each different type of surgery poses different challenges to the surgical, medical, and anesthesia providers. Current literature supports the use of the enhanced recovery pathways (ERP), also called enhanced recovery after surgery (ERAS). The goal of the pathway is to hasten surgical recovery and decrease the stress response through a team approach. Common ERP interventions include oral fluids and carbohydrate supplements up to 2 h prior to surgery, euvolemia, postoperative nausea/vomiting prophylaxis, early oral nutrition, and ambulation on first surgical day. Enhanced recovery after surgery minimizes the use of traditional care such as nasogastric tubes, bowel preparations, NPO after midnight, and excessive intravenous opioids (Nelson et al., Gynecol Oncol 35 (3):586-594, 2014). Anesthesia teams require knowledge in using ERAS protocols in conjunction with a variety of medications and techniques. Enhanced recovery pathways are shown to reduce hospital stay and cost and are considered a standard of care for gynecological surgical patients at some hospitals [17]. The purpose of this chapter is to examine current data related to anesthetic management of patients undergoing surgery for gynecological malignancies and provide an overview of postoperative management.