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Use of general anesthesia and sentinel node procedure during pregnancy
Author(s) -
Gziri Mina Mhallem,
Han Sileny N.,
Amant Frédéric
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23164
Subject(s) - obstetrics and gynaecology , medicine , university hospital , general hospital , gynecology , family medicine , pregnancy , genetics , biology
We read with great interest a report by Broer et al. [1] on themanagement of melanoma during pregnancy. We agree that cancertreatment in pregnant women is a challenge though have a concernabout recommendation of the resection of the primary tumor underlocal anesthesia and postponing the sentinel node procedure (SLN)after delivery.We believe that treatment should adhere as much as possible tostandard treatment, including for the treatment of melanoma.The authors recommend the local anesthesia to avoid fetal risksaccording to two papers published in 1986 and 1990 [2,3]. Surgeryduring pregnancy is performed under local or general anesthesia afterdiscussion with the obstetricians, surgeons, anesthetists, and pediatri-cians. Potential risks of surgery are linked to anesthetic agents butespecially to complications during and after surgery: hypotension,hypoxia, hypoglycemia, fever, infection, and thrombosis. Therefore aleft lateral tilt position, adequate analgesia, antibiotics, and thrombosisprophylaxia are recommended [4]. It is recommended to postpone thenon-emergent surgery after the rst trimester of pregnancy to avoidabortions and preterm labor [4]. In a series of 12,000 cases, Cohen-Kerem et al. [5] described an increased risk of fetal loss only afterperitonitis. Van Calsteren et al. [6] described no increase of fetal mal-formation and fetal death after surgery under general anesthesia forseveral types of cancers and most of preterm deliveries are iatrogenic.During pregnancy, most experience with the SLN technique hasbeen gained in the eld of breast cancer. The SLN technique withtechnecium for breast cancer is safe during pregnancy and does notincrease risk of malformation and fetal death [7]. Fetal radiation isdoes not exceed 0.05 mSV with technetium and 1 day protocol. Thereason is that low dosages are used and that radioactivity is capturedin the lymph node. The short termination half-life adds to low sys-temic exposure to radioactivity. The use of blue dye is avoided be-cause of anaphylactic reactions risk and consequent risks forpregnant women and fetus [8]. We acknowledge that the oncologicalsafety needs to be conrmed. In addition SLN for melanomas andvulvar cancer during pregnancy has been described [4,9,10].Based on these data we believe that in most cases standard surgi-cal treatment for melanoma is possible during pregnancy, includinggeneral anesthesia and the SLN procedure.