Severe lung disease and caecal cancer

79-year-old man for laparoscopic Right Hemicolectomy on a background of Caecal cancer

Background:

  • COPD – Current Smoker
  • Pulmonary Fibrosis – New diagnosis on staging CT
  • Multiple previous abdominal surgeries including AAA repair and aorto-bifemoral bypass grafting
  • Alcohol excess
  • Impaired fasting glucose

Issues:

  • Surgical concern regarding the potential difficulties or laparoscopic surgery and chance of having to open
  • PFT’s – significantly reduced TLCO = 16% and FEV1/FVC = 0.53 in setting of COPD and new diagnosis of pulmonary fibrosis
  • Asymptomatic, DASI = 5.8. Plays bowls

Discussion:

Epidural Anaesthesia

  • High chance of conversion to open
  • Multiple risk factors for postoperative pulmonary complications
  • Consensus that there are many options for regional anaesthesia if converts to open surgery
  • Preoperative discussion with surgeon to confirm best technique for analgesia

Disposition

  • Ideally ICU 2 postoperatively given co-morbidities and likely long and difficult surgery/possible open procedure
  • Would it be reasonable to proceed if no ICU bed available?
  • Consensus was no, this patient should have post-operative HDU as a minimum standard of care

Plan:

  • Proceed as planned
  • Regional anaesthesia recommended, technique as per surgeon and procedural anaesthetist
  • Postoperative ICU 2