Avaliação de Risco Cirúrgico em Doentes de Câncer

Abstract

The evaluation of the surgical risk in patients with câncer must take into account, not only the pathology related to the malignant growth, but also the presence of associated diseases. Age, nutrition, mental status and the type of the operation planned are factors that influence the rates of morbidity and mortality. Anemia, nutritional deviations and endocrine disfunctions must be corrected and controlled in a short time. Severe hepatic and renal insuficiency, as diagnosed by clinical and laboratory methods, are absolute contra indications to major surgery. Patients with pulmonary insufficiency do not survive lung ressections. They are poor risks for abdominal surgery unless carefully prepared throug thecniques for the management of bronchospasm and for the liquefaction and elimination of tracheobronchial secretions. Tracheostomy may be advantageous, in selected cases, if performed previously to surgery. Congestive heart failure, acute myocardial infarction during the first six weeks, chronic cor pulmonale, constrictive pericarditis, are absolute contra indications to major surgery. The drug treatment of patients with malignant hypertension should be continued throught out the whole surgical procedure in order to prevent sudden, dangerous blood pressure rises and vascular disaster. All types of arrhythmias should be controlled preoperatively because they may precipitate ventricular tachycardia, ventricular fibrillation and death.