Gastrointestinal (GI) oncology presents a uniquely complex and evolving
landscape for anesthesiologists, requiring a thorough understanding of tumor biology,
surgical approaches, and perioperative physiology. This chapter provides a
comprehensive overview of anesthetic management in patients undergoing surgery for
GI malignancies, including esophageal, gastric, colorectal, hepatobiliary, pancreatic,
and stromal tumors. The discussion emphasizes the interplay between anatomical
considerations and surgical demands, as well as the anesthetic implications of cancerrelated physiological derangements such as cachexia, malnutrition, anemia, and
immunosuppression.
A focused approach to preoperative optimization, including Enhanced Recovery After
Surgery (ERAS) protocols and prehabilitation strategies, is presented alongside a
detailed review of anesthetic techniques—ranging from total intravenous anesthesia
(TIVA) to regional modalities—and pharmacological considerations unique to
oncologic surgery. Procedure-specific challenges are analyzed in the context of
esophagectomy, gastrectomy, hepatectomy, pancreaticoduodenectomy, and carcinoid
tumor resection, with particular attention to fluid management, pain control, and
intraoperative monitoring.
Additionally, the chapter addresses the growing evidence linking anesthetic
management to long-term oncologic outcomes, including tumor recurrence and
immune modulation. It concludes with a forward-looking discussion on emerging
practices in immunomodulatory anesthesia, ERAS innovations, and the role of
anesthesiology in optimizing return to intended oncologic therapy (RIOT). This chapter
aims to serve as a practical and evidence-based reference for anesthesiologists
managing patients with GI cancers in high-acuity surgical settings.
Keywords: Blood transfusion, Enhanced Recovery After Surgery (ERAS), GI oncology anesthesia, Multimodal analgesia, Opioid-sparing, Regional anesthesia.
