73yo male for R VATS and wedge resection for one of multiple lesions, presumed to be metastatic spread from unknown primary

Background

• Partial gastrectomy ’04 for cancer
• Oesophagectomy ’14 for cancer, subsequent strictures requiring dilatations 
• Bladder Ca – diathermy based treatment, now under surveillance
• HOCM w/ ASM + LVOTO, TTE 2022 gradient stable 39/15
• IHD – minor L main disease, 70% LAD proximal lesion, + aneurysm, minor LCx, 40% RCA -> medically managed
• Asbestosis – pleural plaques and coarse fibrosis R lung
• Recent GAs well tolerated
• DASI 6 METS

Issues

• Long QT on clinic ECG – Nil obvious culprate medications, asymptomatic, 480ms
• BSL 3.1 in clinic – nil hx or symptoms
• Perioperative risk – RCRI class 3

Discussion

• What is the primary cancer – Multiple previous cancers although reasonably distant. Tissue diagnosis needed for further oncology treatment
• Low BSL in clinic – endocrine suggested morning cortisol and HbA1c
• Overall co-morbidities, while significant, are stable. Reassured by good exercise tolerance and history of daily purposeful exercise.

Plan

• For early morning cortisol, HBa1c, CMP, EUC
• Proceed to OT
• Warning note for HOCM