Ca Endometrium with Long-Standing Diabetes Mellitus for Radical Hysterectomy

Endometrial cancer is strongly associated with diabetes mellitus and obesity in elderly women. Treatment of endometrial cancer involves a major onco-surgery in the form of total hysterectomy with bilateral salpingo-oophorectomy and bilateral pelvic lymphadenectomy. Long-standing diabetes mellitus being a multisystem disease, careful assessment of functions of the vital organs is an important part of preoperative evaluation. Preoperative optimization includes correction of anemia, nutritional replenishments, physiotherapy exercises, and optimization of glycemic control using oral hypoglycemic agents and insulin. Principles of intraoperative care include the provision of good analgesia, careful titration of drugs to prevent fluctuations in hemodynamic parameters, administration of adequate fluids to replace the blood loss and to ensure tissue perfusion, and safe recovery from anesthesia. Blood sugar levels should be carefully controlled within the targets of 120–180 mg%. Postoperative care includes adequate pain relief, early ambulation, thromboprophylaxis, early resumption of enteral nutrition, and management of any acute hyperglycemic complications. In short, meticulous evaluation, vigilant monitoring, and execution are the keys to success in a diabetic patient undergoing major onco-surgery.