Gynaecological Oncology, Advanced Pelvic Exenteration, and Complex Cytoreduction — WACS Viva & Clinical Scenarios (Gynaecology)

Exam-style gynaecological oncology, advanced pelvic exenteration, and complex cytoreduction viva scenarios with examiner probes and model answers for…

Scenarios covered

• SCENARIO 1: A 52-year-old woman with Stage IIIC epithelial ovarian cancer and tense malignant ascites presents for extensive cytoreductive surgery, bowel resection, and peritonectomy. Baseline albumin is 24 g/L. Detail your pre-anaesthetic optimisation, induction strategy to prevent rapid-decompression cardiovascular collapse, and intraoperative fluid management.
• SCENARIO 2: A 58-year-old woman with central pelvic recurrence of cervical cancer following chemoradiation is scheduled for an anterior pelvic exenteration (radical cystectomy, hysterectomy, and ileal conduit). The surgery is anticipated to last 7 hours with extensive blood loss. Formulate your anaesthetic, invasive monitoring, and analgesia plan.
• SCENARIO 3: During cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) with cisplatin at 42°C for an ovarian malignancy, the patient becomes progressively hyperthermic (core temperature 39.5°C), tachycardic (HR 138 bpm), and oliguric. Describe your anaesthetic management of the thermal, metabolic, and renal consequences of HIPEC.
• SCENARIO 4: A 62-year-old cachectic woman with Stage IV cervical carcinoma presenting with severe chronic pelvic pain, obstructive uropathy (creatinine 280 µmol/L), and bilateral ureteric stents is scheduled for radical palliative debulking. Discuss your pharmacological choices for anaesthesia induction, maintenance, and pain control in the presence of severe renal impairment.