A Case of Perioperative Management of Tongue Cancer Polycythemia Vera

Polycythemia vera is a chronic myeloproliferative neoplasm characterized by a marked increase in circulating erythrocyte volume in middle-aged and elderly patients; it is associated with increased white blood cell and platelet counts and splenomegaly. There is a high risk of conflicting complications during surgical treatment, such as thrombosis and hemorrhage, with thrombosis being the leading cause of death. Hence, it is important to take measures against both in the perioperative management. We report a case of perioperative management of a patient with polycythemia vera and resection of an intraepithelial carcinoma of the tongue. The patient, a 46-year-old man, had been under observation at our hospital's Department of Internal Medicine for 10 years with a diagnosis of polycythemia vera. He came to our department with a complaint of white spots on the left tongue margin. Phlebotomy was performed when his blood count, hemoglobin, and hematocrit levels were elevated. The biopsy showed intraepithelial carcinoma. Preoperative examination revealed no abnormality, and a partial left-sided tongue resection was performed under general anesthesia. To prevent thromboembolism, the patient wore an elastic stocking from the time he entered the operating room. The patient underwent local hemostasis to prevent bleeding and systemic management centered on infusion therapy to prevent blood concentration. Four years and three months have passed since the surgery without recurrence.