Anaesthetic perioperative management of patients with pancreatic cancer

·      Postoperative complications such as primarily pancreatic fistula, haemorrhage, abscess, and delayed gastric emptying still occur at a frequency of 30% to 60%, resulting in a mortality rate of 1% to 5%[11].

·      For this reason and due to the lethality of the pancreatic cancer despite surgical treatment, the patient should be informed about the therapeutic procedure and any potential complications or disabilities to facilitate a conscious involvement in the decision-making process.

·      In the case of patients of advanced age who require pancreatic surgery, formal mental status testing can help determine whether a patient can be considered capable of making this type of decision.

Dementia is an extreme predictor of poor outcome, exhibiting surgical mortality rates that are increased by 52%[12]. The decision to classify an elderly patient eligible for surgery cannot exclude preoperative mental status.

Preoperative risk assessment

A complete history, physical, laboratory examinations, and an assessment of the surgical risks should be included in the preoperative evaluation of an elective surgery.

Recently, a variety of scoring systems has been developed, and the Physiologic and Operative Severity Score for the Enumeration of Mortality and morbidity (POSSUM) model by Copeland et al[14] was recognized as the most effective for general surgery[15].

This model, which uses scores relating to 12 physiological and 6 operative variables, was developed to postoperatively predict 30-d mortality and morbidity.

The application of the predictive POSSUM and P-POSSUM (Portsmouth modification of POSSUM)[16] models to cases of pancreatic surgery has generated conflicting results.

The implementation of this scoring system in the routine practice has proven to be difficult, and a recent review by Wang et al[17] has found POSSUM to overpredict postoperative mortality. Despite these limitations, there is still a role for POSSUM as a useful tool in pancreatic surgery. Individual POSSUM scores should not preclude pancreatic resec- tion in clinical practice but might help surgeons modify expectations of postoperative outcomes[18]. Due to the limitations of the POSSUM model, more trials are needed to adequately evaluate this scoring system in predicting postoperative mortality for pancreatic surgery.