Evaluation of Anesthesia Applications and Postoperative Care Results in Patients Who Underwent Reconstruction Surgery with Tumor Resection Prosthesis in Primary and Metastatic Bone Tumors

INTRODUCTION: Patients scheduled for orthopedic oncological surgery often receive various treatments, such as chemotherapy or radiotherapy, before the operation. The treatments applied and related side effects, accompanying co-morbidities and the characteristics of the surgery to be performed affect the choice of anesthesia and require specificity. In this study, it was planned to retrospectively evaluate the patients who underwent tumor resection prosthesis with the diagnosis of primary or metastatic bone tumor in our hospital.
METHODS: 72 patients between the ages of 6-84 who underwent tumor resection prosthesis operation with the diagnosis of primary or metastatic bone tumor and who are in American Society of Anesthesiologists (ASA) I-III group were included in the present study. Demographic characteristics of patients, accompanying diseases, malignity diagnoses, ASA scores, surgical intervention carried out and anesthesia method, duration of anesthesia and operation, pre and postoperative hemoglobin values, amount of intraoperative bleeding, intraoperative fluid management and need for blood transfusion, need for and duration of postoperative intensive care and/or mechanic ventilation were recorded
RESULTS: The most frequently diagnosed primary bone tumor was osteosarcoma, and the most common operation was wide tumor resection and femoral proximal tumor resection prosthesis. Parameters such as duration of anesthesia, amount of bleeding, age, ASA, and comorbidity were shown to be associated with the need for postoperative mechanical ventilation or intensive care. In the postoperative analgesia methods applied to the patients, it was seen that the most frequently preferred method was intravenous analgesia.
DISCUSSION AND CONCLUSION: In orthopedic oncologic surgeries, anesthesia management should encompass evaluating the patient with a holistic approach starting from the preoperative period, and considering the need for postoperative analgesia and/or for intensive care in addition to intraoperative anesthesia. Communication between members of anesthesia and surgery teams is important for providing optimal surgical care.

Primer ve Metastatik Kemik Tümörlerinde Tümör Rezeksiyon Protezi ile Rekonstrüksiyon Cerrahisi Yapýlan Hastalarda Anestezi Uygulamalarý ve Postoperatif Bakým Sonuçlarýnýn Deðerlendirilmesi

GÝRÝÞ ve AMAÇ: Ortopedik onkolojik cerrahi planlanan hastalar sýklýkla operasyondan önce kemoterapi veya radyoterapi gibi çeþitli tedaviler almaktadýr. Uygulanan tedaviler ve bunlara baðlý yan etkiler, eþlik eden ko-morbiditeler ve yapýlacak olan cerrahinin özellikleri anestezi seçimini etkileyerek spesifikleþmeyi gerektirir. Bu çalýþmada, hastanemizde primer veya metastatik kemik tümörü tanýsý ile tümör rezeksiyon protezi uygulanan hastalarýn retrospektif olarak deðerlendirilmesi planlandý.
YÖNTEM ve GEREÇLER: Çalýþmaya hastanemiz Ortopedi ve Travmatoloji Kliniði tarafýndan Ocak 2015 ve Aralýk 2016 tarihleri arasýnda Primer veya metastatik kemik tümörü tanýsý ile tümör rezeksiyonu protez operasyonu uygulanan, American Society of Anesthesiologists (ASA) I-III grubunda yer alan 6-84 yaþ arasý 72 hasta bu çalýþmaya dahil edildi. Hastalarýn demografik özellikleri, eþlik eden hastalýklarý, malignite tanýlarý, ASA skorlarý, yapýlan cerrahi giriþim ve anestezi yöntemi, anestezi ve operasyon süresi, ameliyat öncesi ve sonrasý hemoglobin deðerleri, intraoperatif kanama miktarý, intraoperatif sývý yönetimi ve kan transfüzyon ihtiyacý, ve postoperatif yoðun bakým ve/veya mekanik ventilasyon süreleri kaydedildi.
BULGULAR: En sýk taný alan primer kemik tümörü osteosarkom, en çok yapýlan ameliyat ise geniþ tümör rezeksiyonu ve femur proksimal tümör rezeksiyon protezi olarak bulundu. Anestezi süresi, kanama miktarý, yaþ, ASA ve ek hastalýk gibi parametrelerin postoperatif mekanik ventilasyon veya yoðun bakým ihtiyacýyla iliþkili olduðu gösterildi. Hastalarda uygulanan postoperatif analjezi yöntemlerinde ise en sýk olarak intravenöz analjezi yöntemi tercih edildiði görüldü.
TARTIÞMA ve SONUÇ: Ortopedik onkolojik cerrahilerde anestezi yönetimi, preoperatif dönemden baþlayarak hastayý bütüncül bir yaklaþýmla deðerlendirmeyi, intraoperatif anesteziyle birlikte postoperatif analjezi ve / veya yoðun bakým gereksinimini belirlemeyi kapsamalýdýr. Anestezi ve cerrahi ekip üyeleri arasýnda iletiþim optimal onkolojik cerrahi bakýmýn saðlanmasý açýsýndan önemlidir.