Anesthesia for major oncological surgery in pregnant patient in the second trimester: case report

Background: Li-Fraumeni syndrome (LFS) is a rare inherited cancer susceptibility disorder with a broad spectrum of tumors in both children and adults. Patients with LFS have a lifetime risk of cancer, and the most common tumors found include soft tissue sarcoma, breast cancer, brain tumors, osteosarcoma, leukemia, and adrenocortical carcinoma. Nonobstetric surgery may be necessary in any trimester of pregnancy, which brings the unique challenges of caring for two patients simultaneously. The case report involved a patient who presented with head and neck tumor and breast tumor during three pregnancies and underwent surgery in the 2nd trimester of the 3rd pregnancy. Case report: The patient’s history began in 2015 during the 3rd trimester of the 1st pregnancy, with a dental abscess and biopsy revealing chondroblastic osteosarcoma of the jaw, awaiting the end of the pregnancy to begin treatment. Two months after birth, right hemimandibulectomy with temporomandibular disarticulation. During the 2nd pregnancy, ductal breast cancer developed, progressing to miscarriage. Chemotherapy and left radical mastectomy with right segmental mastectomy. In the 14th week of the 3rd pregnancy, recurrence with chondroblastic osteosarcoma of the right maxilla, resection indicated in the 2nd trimester, and right partial maxillectomy was performed under multimodal general anesthesia, without compromising the fetus. Conclusion: Non-elective surgeries should never be denied to pregnant patients, although it is recommended to postpone elective cases until 6 weeks after delivery. Consultations with obstetrics, neonatology, anesthesiology and surgery teams are essential for the care of the patient, regardless of the type of surgery. This meeting was held with the various teams and family members, resulting in a successful outcome after the right subtotal maxillary surgery, with a viable fetus and birth a few weeks after surgery.