# Critical Care Management of Surgically Treated Gynecological Cancer Patients: Current Concepts and Future Directions

## TL;DR

This review explores how critical care can improve outcomes for gynecological cancer patients after surgery, highlighting the need for better strategies and guidelines.

## Contribution

The paper introduces the concept of structured critical care management for gynecological cancer patients, a topic largely unaddressed in the literature.

## Key findings

- Critical care management is underexplored in gynecological cancer patients despite its potential to improve outcomes.
- Advances in treatment have increased survival, but perioperative monitoring guidelines remain lacking.
- Critical care can be provided in PACU, HDU, or ICU, depending on patient needs and should be used judiciously.

## Abstract

Critical care management in surgically treated gynecological cancer patients has not been investigated yet, despite the fact that it may considerably help improve patient outcomes. Given the significant impact that the advancements made in the last 20 years in the treatment of gynecological cancer patients have on patient survival, it seems reasonable to discuss the need for innovative strategies that will target an intensive management of patients with various medical conditions that are precluded from optimal treatment plans due to comorbidities that were previously considered contraindications for aggressive management. The present review discusses how critical care management should be structured in gynecologic oncology and how it can help ameliorate outcomes of surgically treated patients.

The significant advances in the surgical and medical treatment of gynecological cancer have led to improved survival outcomes of several subgroups of patients that were until recently opted out of treatment plans. Surgical cytoreduction has evolved through advanced surgical complexity procedures and the need for critical care of gynecological cancer patients has increased. Despite that, however, articles focusing on the need of perioperative monitoring of these patients completely lack from the international literature; hence, recommendations are still lacking. Critical care may be offered in different types of facilities with specific indications. These include the post-anesthesia care unit (PACU), the high dependency unit (HDU) and the intensive care unit (ICU) which have discrete roles and should be used judiciously in order to avoid unnecessary increases in the hospitalization costs. In the present review we focus on the pathophysiological alterations that are expected in gynecological cancer patients undergoing surgical treatment, provide current evidence and discuss indications of hospitalization as well as discharge criteria from intensive care facilities.