Is Radical Bowel Cancer Resection Under Local Anaesthesia and Sedation Feasible?

Abstract

Some patients with bowel cancer have significant comorbidities, making them unfit for major surgery under general anaesthesia. However, treatment without surgery offers no possibility of cure, and furthermore, symptom control may be poor. We investigated the possibility of performing these resections under local anaesthesia in patients with a slim body habitus in a cohort of patients rejected for general anaesthesia. Eight patients (4 M, 4 F) aged 77-89 were included in this study. All had significant comorbidities and were deemed unfit for general anaesthesia by the consultant anaesthetist in charge of pre assessing high-risk patients. All patients had undergone a thorough assessment, which included P-POSSUM scoring. The recruited patients underwent a careful and fully informed consenting process, leading to standard cancer resections. These resections occurred between 2005 and 2012, under combined local anaesthesia and sedation. The operations undertaken were four right hemicolectomies (for caecal cancer), two Hartmann's procedures (for sigmoid cancer), one Hartmann's procedure with en bloc small bowel resection (for sigmoid cancer invading small bowel) and one transverse colectomy (for mid transverse colon cancer). Seven patients survived radical surgery without complications, although one died from an unrelated cause 8 months after surgery. One of these surviving patients subsequently underwent CABG and further bowel surgery under GA 2 years later for a metachronous sigmoid cancer. There was one postoperative death due to cardiogenic shock on the third postoperative day. Radical cancer resections under local anaesthesia are feasible in suitably selected high-risk patients with acceptable mortality and comparable medium-to long-term results.

Awake Colostomy Under Regional Anesthesia in Frail Patients

“…Local anesthesia, in conjunction with intravenous fentanyl, was used in a case series of 8 patients for colon cancer resections via low midline or transverse abdominal or lower midline incisions. 4 Although they initially had comorbidities prohibitive of general anesthesia, the patients had acceptable postoperative outcomes after colonic resection under local anesthesia. By the same token, in a case series of 17 patients, local anesthesia was successfully used as an alternative to general anesthesia for ileostomy closure.…”