Clinical Safety and Feasibility of Minimally Invasive Colectomy Under Neuraxial Anesthesia in Frail Patients: Preliminary Case Series

Background/Objectives: General anesthesia is the most widely used anesthesia technique for major abdominal surgery, but it may have a longer recovery time, high cost, and environmental impact. In addition, general anesthesia may be contraindicated in some frail patients. Our study aims to evaluate the feasibility and safety of performing colorectal surgery with a minimally invasive technique in frail patients under spinal anesthesia. Methods: From June 2021 to January 2022, 39 consecutive frail patients, undergoing elective laparoscopic colorectal oncological resection surgery under neuraxial anesthesia at the Colorectal Surgery Unit of the Fondazione Policlinico Campus Bio-Medico in Rome, were selected. A retrospective analysis prospectively maintained database of these patients was performed. Results: In all 36 patients, the surgery was successfully completed under spinal anesthesia and laparoscopic technique. Some patients experienced mild abdominal pain between I and II POD (Post Operative Day) (Visual Analogue Scale between 3 and 5) and were treated with oral analgesics as needed. No patients experienced episodes of vomiting or nausea after surgery with gas channeling in I POD. The average hospital stay was about 4 days (range 3-7). No patient required ICU (Intensive Care Unit) admission, and 30-day mortality was 0. Conclusions: Our preliminary data show that performing major surgery with a minimally invasive technique under spinal anesthesia can be feasible and safe, if performed by experienced operators, and can be a viable alternative for the treatment of frail and/or high-risk patients.