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Preoperative evaluation and management of patients with cancer

Ellen F Manzullo, MD, FACP
Sunil K Sahai, MD, FAAP, FACP
Harrison G Weed, MS, MD, FACP
Section Editor
Reed E Drews, MD
Deputy Editor
Sadhna R Vora, MD


The preoperative management of the patient with cancer can be complex. While patients with cancer are similar in many ways to those without cancer, the direct and indirect (systemic) effects of the cancer and the side effects of cancer therapy can influence perioperative evaluation and management. Here we will provide an overview of issues that are relevant to patients with current or past cancer. General preoperative evaluation and estimation of cardiac risk from surgery are discussed elsewhere. (See "Preoperative medical evaluation of the adult healthy patient" and "Evaluation of cardiac risk prior to noncardiac surgery".)

The preoperative medical evaluation of cancer patients should include an assessment of nutritional status, functional status, and symptom control (particularly regarding cancer-related pain) in addition to an assessment of general medical issues. The natural history of the cancer and effects of any prior chemotherapy or radiation therapy should also be considered. The short- and long-term outcomes of cancer surgery in older patients can be equivalent to those in younger patients. Treatment considerations should be based on functional status, not on chronological age [1]. (See "Comprehensive geriatric assessment for patients with cancer".)

The timing and purpose of the cancer surgery can affect perioperative evaluation. While rarely emergent, cancer surgery is usually not elective, and therefore the amount of time available to medically optimize a patient may be limited.

There is growing recognition that a patient’s physiologic fitness for surgery plays a role in reducing perioperative complications. Patients with cancer tend to be deconditioned due to numerous factors. In this situation, where patients are taking numerous insults to their overall functional status, it may be beneficial to enroll patients into a prehabilitation program as soon as a cancer diagnosis is made (figure 1).

In addition to managing coexisting medical conditions, the internist may also play an important role in coordinating the many complex levels of care provided by surgeons, medical oncologists, radiation oncologists, and others.

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Literature review current through: Nov 2017. | This topic last updated: Aug 21, 2017.
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