ECG, noninvasive blood pressure, oxyhemoglobin saturation, and urine output are the essential monitoring items in any surgical procedures.

The operators should understand timely the statuses of the hemodynamics, pulmonary circulation, and cardiac function and maintain a stable circulatory function.

PetCO₂ must be monitored during the implementation of the oncoplastic surgery under general anesthesia, and the normal value is 4.66–6.00 kPa (35–45 mmHg). PetCO₂ monitoring has the following advantages: (1) Whether the endotracheal catheter is located within the trachea can be determined from end-tidal carbon dioxide waveform. (2) It can provide guidance in the setting of respiratory parameter. If PetCO₂ is increased higher and higher, this will indicate insufficient ventilation and carbon dioxide accumulation. On the contrary, if PetCO₂ is decreased lower and lower, this will indicate excessive ventilation, and it is needed to reset the parameters of the anesthesia respirator. (3) If the end-tidal carbon dioxide waveform is presented as a straight line, this usually suggests that the catheter has fallen off. (4) If PetCO₂ is unusually decreased, this suggests the possibility of massive blood loss.

The duration of oncoplastic surgery is longer, and the changes in body temperature should be continuously monitored during surgery.

During surgery, Bis or Neotrend can be used to continuously monitor the anesthesia depth, and the muscular relaxation monitor is used to continuously observe the muscle relaxation to keep the patient at an appropriate level of anesthesia and avoid that the light anesthesia may cause body movement in the patient and thus lead to the intraoperative awareness and even affect surgical operation; it should be avoided that too deep anesthesia induces delayed postoperative recovery and increases the incidence of postoperative respiratory complications.

The intracranial pressure should be continuously monitored during the large craniofacial surgery, and the intracranial pressure can be regulated and controlled timely in a relatively safe range according to the dynamic monitoring results. A certain depth of anesthesia is maintained during surgery to avoid agitation and movement. Some methods can be used to reduce the intracranial pressure when necessary: (1) The hyperventilation is carried out. If PetCO2 is controlled between 25 and 30 mmHg, a sufficient decrease in the intracranial pressure can be achieved; (2) the right amount of mannitol or glycerin fructose is intravenously infused; (3) the adrenal cortical hormone is applied; (4) the subarachnoid catheter placement is performed to drain the cerebrospinal fluid.

Blood gas analysis and electrolyte can be determined for avoiding hypoxia, carbon dioxide accumulation, and acid-base imbalance; the blood glucose can be determined for maintaining a stable blood sugar level and preventing the occurrence of high blood sugar or hypoglycemia; the hemoglobin (Hb) and hematocrit (Hct) can be determined for guiding the intraoperative blood transfusion and maintaining an appropriate degree of blood dilution.

The oral intubation, nasal intubation, and transtracheostomy intubation are available for selection. The oral intubation is firstly preferred, and it can prevent the damage to the nasal mucosa caused by the tube. But the oral intubation is not conducive to postoperative indwelling tube. Therefore, for the patients who may have difficulty breathing after surgery, it is preferable to carry out the nasal intubation and transtracheostomy intubation.

The intubation under intravenously induced rapid anesthesia, the awake intubation under topical anesthesia, and the intubation under inhalation anesthesia are available for selection. The tools which are used to examine the glottis include ordinary laryngoscope, video laryngoscope, rigid laryngoscope, fiber-optic laryngoscope, etc. The tools for managing the difficult airway also include laryngeal mask, esophageal-tracheal combined tube, blind tracheal intubation instrument, optical cable, thyrocricotomy devices, and percutaneous tracheostomy devices.

The endotracheal tube is properly fixed. A long extension tube and an end-expiratory carbon dioxide sensor are connected to the anesthesia respirator for mechanical ventilation. The parameters of the respirator are set according to the specific circumstances of the patient and are adjusted at any time in accordance with oxyhemoglobin saturation, end-tidal carbon dioxide partial pressure, and blood gas analysis results. The anesthesiologists should always observe the position of the tube to prevent twisting, folding, and slippage of the tube and observe the color change of the carbon dioxide absorbent, which should be replaced in time combined with the objective indicators such as end-tidal carbon dioxide partial pressure.

The modern view is that the volume replacement not only aims to maintain hemodynamic stability, avoid volume overload, and ensure the normal blood clotting function and renal function, more importantly, but it also aims to guarantee the tissue oxygen supply and optimize the tissue perfusion. Therefore, selecting the appropriate plasma substitute is the key for safe and effective volume replacement. The anesthesiologists should select the appropriate plasma substitutes based on the characteristics of the patient’s disease, blood pressure, central venous pressure, and urine output changes to replenish the fluid volume for fluid loss and redistribution as well as the evaporation in wounds and surgical field due to the preoperative fasting, surgical trauma, and anesthesia and ensure adequate volume and microcirculation in the patient.

The ideal plasma substitute should have stable physical and chemical properties, and it can quickly supplement the blood volume, increase tissue perfusion, and have sufficient residence time in blood vessels. Meanwhile, it has no significant effects on the blood clotting function and the renal function and has no allergic reaction and tissue toxicity. It can improve oxygen supply and organ function, and it is easily metabolized and removed in the body.

Plasma substitutes can be divided into two categories according to the relative molecular mass size, namely, the crystalloid solution and the colloidal solution. The solution, in which the diameter of the solute molecule or ions is less than 1 nm, or it will not generate a light reflex phenomenon when it is penetrated through by the light beam, is called the crystalloid solution, such as normal saline, Ringer’s lactate solution, invert sugar and electrolyte solution, and hypertonic saline; the solution, in which the diameter of the solute molecule or ions is greater than 1 nm, or it will generate a light reflex phenomenon when it is penetrated through by the light beam, is called the colloidal solution. The colloid is divided into three categories according to different structures: (1) proteins (gelatin), such as human serum albumin, succinylated gelatin (Gelofusine), and polygeline; (2) starches (polysaccharide), such as hydroxyethyl starch (706 plasma substitute, HES, Voluven) and dextran (70, 40); and (3) others, such as hypertonic sodium chloride hydroxyethyl starch (Holme).

The effect of expanding blood volume and the adverse reactions are compared between the plasma substitutes, and the results showed that the colloidal solution is superior to crystalloid solution. The natural colloid albumin has limited resources and is expensive and has a risk of spreading disease. In the clinic, it is only used in special circumstance such as correcting hypoalbuminemia. The gelatin solution in artificial colloid has a relatively small molecular mass and a less impact on blood clotting function, but its duration of action on expanding blood volume is shorter. At the same time, it has a higher risk for occurrence of allergic reaction. The dextran solution has a relatively large molecular mass, and the duration of its action on expanding blood volume has been extended to some extent compared with the gelatin solution, but it also has an increased impact on blood clotting function. The effect of expanding blood volume of hydroxyethyl starch is best, and the old-generation hydroxyethyl starch with higher relative molecular mass, degree of hydroxyethylation, and C2/C6 ratio has a longer duration of action on expanding blood volume, but it has a greater impact on blood coagulation and renal function; while the new-generation hydroxyethyl starch with middle molecular mass (HES, Voluven) not only retains the effectiveness of expanding blood volume of the old-generation hydroxyethyl starch, it also greatly reduces the impacts on blood coagulation and renal function. It can significantly improve visceral blood flow and oxygenation, prevent capillary leakage, reduce capillary permeability, reduce the endothelial cell activation after ischemia-reperfusion, reduce endothelial injury, and maintain the stability of endothelium, thereby reducing the inflammatory response. Its allergic reaction incidence rate is the lowest in all colloidal solution used in clinic; thus, it becomes a more ideal colloidal solution.

Preoperative autologous blood donation (PABD) refers to that a certain amount of autologous blood are collected several times from the patient at 2–4 weeks before surgery and then are stored, and these autologous blood will be infused back into the patient on the day of surgery to meet the need of surgical blood. In the process of preoperative blood storage, the patient can take oral iron supplements and be treated with erythropoietin to promote erythropoiesis. PABD requires that the patient is in generally good condition, with no anemia (Hb > 110 g / L, Hct > 33%) and no serious heart and lung disease. Its main advantage is that it causes no antigen-antibody reaction and is relatively safe, and it can economize the source of blood and has no infectious diseases. It is mostly suitable for patients with a rare blood type and the allergy to foreign proteins; its main drawback is that the blood may be contaminated in the process of collecting blood, and the hemolytic reaction may occur in the stored blood, and thus the length of stay of the patient is longer. Walther-Wenke et al. made a statistics on related reactions to 22,630 autologous blood transfusions in 21,553 patients which were reported in the relevant literatures and found that the incidence of sepsis was markedly lower than that in patients receiving allogeneic blood transfusion, and the incidence of blood transfusion reaction was also very low, which was about 1/4500. The main problem is that sometimes the operational errors may appear.

The acute normovolemic hemodilution (ANH) refers to the blood conservation method that the anesthesiologist collects a certain amount of blood from the artery or deep vein of the patient and stores it for a while after anesthesia induction and before the start of surgery; meanwhile, the circulating blood volume of the patient is supplemented with colloidal solution (1:2), and the diluted blood is used to maintain the function of circulation during surgery, minimize the hematocrit, and thus reduce the absolute loss amount of red blood cells in the blood; then the collected blood is reinfused into the patient before the end of surgery. ANH is simple and operable, and it costs less compared with preoperative autologous blood storage or application of recombinant erythropoietin and the intraoperative or postoperative autologous blood recovery. The collected blood is stored at room temperature in the operating room, it is less error-prone, and the blood will not be contaminated.

The acute normovolemic hemodilution is a relatively safe measure for effective blood conservation. According to some basic researches, ANH, combining with controlled hypotension, can cause hypoxia-ischemia brain injury when Hct ≤ 20%, which demonstrates as the mitochondrial degeneration in the hippocampal CA1 region, nuclear enrichment, aggregation, and nuclear membrane deformation. Furthermore, the expressions of NF-_кB and tumor necrosis factor-α (TNF-α) in the cerebral cortex are increased; thus, it is recommended that ANH combined with controlled hypotension should be avoided when Hct ≤ 20%.

The acute hypervolemic hemodilution (AHH) refers to that the patent is rapidly infused with a certain amount of crystalloid solution or colloidal solution (20–25 ml/kg) after anesthesia induction and within 25–30 min before surgery, while the autologous blood is not collected, so that the hematocrit is reduced into the physiological limits. The patient is supplemented with the same amount of colloidal solution for the intraoperative bleeding and with the same amount of crystalloid solution for the urine and evaporated water in surgical field, so that the blood volume remains in the hypervolemic state during surgery. AHH is simple and operable, and it has good timeliness and causes little damage to the blood components.

Mielke et al. observed the effects of ANH and AHH on parameters such as the intraoperative and postoperative blood loss, the proportion of allogeneic blood transfusion, postoperative hemoglobin, hematocrit, platelets, and blood clotting function and found that there are no significant differences between ANH and AHH, but the ANH is more time-consuming, and it costs more. Therefore, it is considered that the patient with about 1000 ml of estimated blood loss can be treated with AHH instead of ANH.

Before resection of the primary lesion in the oncoplastic surgery, it is considered to use some antifibrinolytic drugs with short half-life to reduce the blood loss and allogeneic blood transfusion caused by the resection of the primary lesion.

But it is not advocated that the antifibrinolytic drugs are applied after the primary lesion is resected and the bleeding is stopped, in order to avoid the effect of the blocking of the anastomosed blood vessel on the blood supply of the skin flap.

The intraoperative blood loss can be reduced through performing controlled hypotension when the primary lesion is resected.

In order to save blood resource, it is mostly advocated that the principle of supplementing what the patient lacks should be abided by. The red blood cells can be infused to maintain a certain degree of hematocrit and carry oxygen for tissue cells to use, and the patient with blood loss of more than 20% of blood volume should be supplemented with red blood cells. The plasma is mainly infused to expand the blood volume, and the fresh frozen plasma contains some fibrinogens and blood coagulation factors. The patient with massive blood loss (more than 50% of blood volume) should be supplemented with plasma according to 10 ml/kg, and this can play a certain role in preventing secondary hyperfibrinolysis at the same time of expanding the blood volume. Because the blood platelets and cryoprecipitate must reach a certain concentration to play a better hemostatic effect, and it is more difficult to stop bleeding after large volume hemodilution, it is considered that the patient with a blood loss exceeding 50% of the blood volume should be supplemented with blood platelets according to 0.1 U/kg; the patient with a blood loss exceeding 100% of the blood volume should be supplemented with coagulation factors (i.e., cryoprecipitate) according to 0.1 U/kg, and the patient with a blood loss exceeding 100% of the blood volume had better be infused with fresh whole blood. With improvements in surgical techniques, the patients can safely pass through the perioperative period basically through blood component transfusion.

The infusion of a lot of blood at 4 °C will cause the temperature to decrease in the patient, and sometimes it can be decreased to 34 °C, and thus this leads to a series of biochemical metabolic disorders and the inhibition of cardiac function. Therefore, the banked blood must be pre-warmed; the warming methods include that the blood is warmed by the blood warmers or the blood bag is placed into warm water at 30–40 °C.

When large quantity blood transfusion is needed, it is supposed to use the blood with shorter storage time as far as possible, and the storage time is preferably within 5 days. In fact, in the banked blood which has been stored for 24 h, the activities of platelets have been basically lost; in the banked blood which has been stored for 3 weeks, from 85% up to 90% of the coagulation factors II and III have been destroyed.

The blood transfusion can cause many acute and chronic phase reactions, especially the acute phase reactions; thus, the anesthesiologist should take an active prevention and treatment.

The vast majority of patients undergoing oncoplastic surgery can successfully regain consciousness in postanesthesia care unit (PACU) after surgery. In individual patients, since the anesthesia time is too long, the trauma is large, the basic condition is poor, or the age is too big, all of these would lead to that the anesthetics accumulate in body, the recovery is delayed, and the breathing recovery is dissatisfied; thereby, the patients need to be transferred into the intensive care unit (ICU) for continuous observation and treatment. The life-threatening phenomenon that the airway is obstructed again after extubation frequently occurs in the patients who have undergone head and neck surgery, and the anesthesiologist should pay particular attention to subtle changes in the patient’s condition and strictly control the extubation indications to prevent the occurrence of accidents. The indications for extubation include:

For the patients who achieve the above conditions, the endotracheal extubation is performed in the presence of a surgeon and with tools to reestablish the airway. If all indicators are normal after extubation, the patient can take a sitting position, and the patient can be sent back to the ward after no symptom of airway obstruction is observed for 30 min.

When the oncoplastic surgery involves the oral, maxillofacial, and cervical areas, the acute upper respiratory tract obstruction may occur due to muscle relaxation, glossocoma, throat or neck swelling, oozing or bleeding, and hematoma compression; the airway obstruction may occur after maxillofacial and cervical surgery due to the commonly used dressing bandage, transarticular flap, elastic fixation in bilateral zygomatic arches, and fixation with steel wire between the two jaws and the missing teeth. If the patient cannot undergo extubation after fully regaining consciousness in PACU, the patient can take the tube back to the ward and is continuously observed for 24–48 h, and the tube is retained maximally for 72 h. The tip of the steel wire flexible tube which is currently used has a small stimulation on airway wall. Under the condition of mild analgesia and sedation, the patient can generally retain the transnasal endotracheal tube for 24–48 h, and the extubation can be performed after the edema subsides. There must be a condition for carrying out tracheotomy when the extubation is performed, in order to establish the airway at any time. If the possibility that the airway will be obstructed again is very large, and there are still a lot of secretions and the edema is obvious after the tube is retained for 24–48 h, it is best to carry out the tracheotomy immediately to ensure patient safety and facilitate expectoration.

The postoperative nausea, vomiting, and restlessness may lead to a contaminated wound and damage the organs and tissues which have been repaired. The restlessness may be due to pain or intravesical catheter stimulation. The nausea and vomiting may be due to that the pharyngeal area is stimulated by the secretions or effused blood, or the stomach is stimulated by swallowed secretions or blood; the nausea and vomiting may also be the adverse reactions of the anesthetic drugs. It should be noted that the fentanyl plus a small dose of anti-inflammatory analgesics is used postoperatively in patient-controlled analgesia to alleviate the pain and also play a mild sedating effect, and this facilitates the patient to have a good rest. At the same time, the 5-HT3 receptor antagonists are routinely used to stop vomiting and prevent the occurrence of nausea and vomiting, and the secretions of the oropharyngeal cavity are cleaned timely by suction to reduce throat irritation.

Statistics show that the complication rate in ICU patients after oncoplastic surgery with an average duration of 9 h reaches 57.4%; the hospital stay in patients older than 60 years is obviously prolonged, and the smokers are more prone to developing short-term complications. According to the American Society of Anesthesiologists (ASA) classification, the survival rate especially the long-term survival rate is lower in patients with grade 3–4 tumors. Another analysis on the complications of 469 cases of head and neck surgery showed that after such surgery, the cardiovascular complication rate is 12%, the respiratory complication rate is 11%, and the incidence of the heart failure is higher than that of the pneumonia. The high-risk period for cardiovascular complications is the first day after surgery, and the high-risk period for respiratory complications is the second day after surgery. The risk factors for cardiovascular complications include age, lung disease, alcoholism, and improper tumor site; the risk factors for respiratory complications include lung disease, pre-existing myocardial infarction, and higher ASA classification. Therefore, for the elderly, weak, and smoking patients after surgery, attention should be paid to preventing the occurrence of lung infections and cardiocerebral events, correcting water and electrolyte disturbances, acid-base balance disorders, and hypoproteinemia and preventing the poor blood supply to the skin flap due to that the blood is too concentrated [25].

The tissue healing is a complex and orderly biological process of the response of tissues to trauma and repair. Theoretically, the tissue healing can be divided into three phases: the inflammatory phase, the fibrous proliferative phase, and the scar formation and reparative phase.

The preoperative radiotherapy refers to that the patient is irradiated with radioactive rays before surgery. In general, the advantages of preoperative radiotherapy are: (1) It can eliminate subclinical lesions (i.e., the small lesions which can’t be detected by current imaging methods). Meanwhile, it can reduce the size of the tumor and release the adhesions; (2) it can increase the surgical resection rate, so that the patients who have been not suitable for surgery or who are inoperable can undergo surgeries; (3) it can reduce the range of surgery and better maintain the physiological and living abilities of the patients after surgery; (4) it can block the small blood vessels and lymphatic vessels around the tumor and reduce the opportunity of metastases through the blood and lymph vessels; (5) it can reduce the viabilities of tumor cells and reduce the chance of intraoperative iatrogenic spread, thereby improving the cure rate.

Approximately 70% of patients with tumors will receive radiotherapy at some stage in the course of disease. Therefore, most oncology surgeons may have the experience of performing the operation on the patients with a history of radiotherapy. The timing of surgery relative to the radiotherapy and the effect of radiotherapy on wound healing and postoperative complications are worth careful consideration.

The radiotherapy can cause the skin and connective tissues to produce the early and late phase reactions. The main cause for the early phase reactions is cytotoxic effect of the radioactive rays on the epithelial cells. The potential mechanisms for the late phase reactions are complex. All lamellar layers of the skin will be involved, and its main feature is the vascular injury and fibrosis. The implement of the operation in tissues which have been treated with radiotherapy can increase the postoperative complications. Therefore, it needs adequate preoperative preparation, attentive perioperative management, and precise surgical technique at the moment. It is also necessary to forewarn patients about the increased likelihood of the postoperative complications.

There are still debates on preoperative or postoperative application of adjuvant radiotherapy and what kind of radiation treatment is best. But the surgeons are more willing to perform postoperative radiotherapy, because what they are worried about is that the preoperative radiotherapy will affect the wound healing and increase surgical complications, and furthermore, it may also increase the risk of tumor recurrence due to the fact that the preoperative radiotherapy narrows the scope of surgical resection.

The clinical studies have shown that the more hypoxic cells exist within the tumor entity, the less sensitive to radiotherapy the tumor is, and the worse the therapeutic effect is. The nourish blood vessels around the tumor before the implementation of preoperative radiotherapy have not been destroyed by surgery. The blood supply to the tumor bed is good, and the tumor cells contain rich oxygen, while the quantity of hypoxic cells is less. Therefore, the tumor is sensitive to radiotherapy. At this moment, the application of radiotherapy has a significant killing effect on tumor cells, and this is very beneficial to reducing the size of the whole tumor and eliminating subclinical lesions to perform organ preservation surgery for tumor patients. The analysis on 229 patients with oral cancers treated in the Cancer Hospital of Chinese Academy of Medical Sciences showed that for patients with T₁ and T₂ lesions, the 5-year survival rate in the preoperative radiotherapy group was the same as that in the simple surgical group; but for patients with T₃ and T₄ lesions, the 5-year survival rate in the preoperative radiotherapy group (40–50Gy) was 60%, and the 5-year survival rate in the simple surgical group was 29.4%. Therefore, the patients with early cancers can undergo simple surgery, but the patients with advanced cancers should be treated otherwise with preoperative radiotherapy [29].

It is not so much that the preoperative radiotherapy has no effect on surgical healing, but if the dose of preoperative radiotherapy is controlled well (i.e., 40–50Gy), this will not cause a significant effect on the surgery in practice. Tupchong compared the data of two groups, namely, the preoperative radiotherapy group (50Gy, 136 patients) and the postoperative radiotherapy group (60Gy, 141 patients), and the results showed that the surgical complication rates in the two groups were 43% and 42%, respectively, of which the serious complication rates were 18% and 14%, respectively. There was no statistically significant difference between two groups. The study of Cancer Hospital of Chinese Academy of Medical Sciences showed that 209 patients with laryngeal cancers were randomly divided into two groups. One group (91 patients) was treated with preoperative radiotherapy (40Gy), and another group (118 patients) was treated with simple surgery. The postoperative complication rate was 25.4% in the preoperative radiotherapy group and was 26.4% in the simple surgery group, and this indicates that the preoperative radiotherapy (40Gy) does not increase the surgical complication rate.

At present, another reason for the surgeons to select less preoperative radiotherapies is that the tumor after radiotherapy is ill-defined and the tumor-free resection margin cannot be guaranteed. But in order to recognize the problem on tumor boundary after radiotherapy, there exist the following two situations: One situation is that the tumor boundary is reduced by the planned preoperative radiotherapy (planned comprehensive treatment), and the surgery is performed at 2–4 weeks after radiotherapy; the other situation is that the tumor recurs after radiotherapy failure. The squamous cell carcinoma is taken as an example. In the formal situation, the boundary is reduced in the vast majority of the tumors, and the peripheral lesions of the tumor are controlled better than the central lesions; thus, the surgical border is guaranteed; while the tumor which recurs after radiotherapy failure often grows under the mucosa, its boundaries are indeed difficult to determine. In addition, the local circumstance is quite different from that before preoperative radiotherapy; thus, it is required to carry out extensive surgery rather than simply reducing the tumor boundary. These two situations should be treated differently.

Sauer et al. conducted a randomized study to determine which was better between preoperative synchronous chemoradiation and postoperative synchronous chemoradiation in the treatment of the rectal cancers (CAO/ARO-094). CAO/ARO-094 randomized controlled study included 823 patients. Through the pelvic CT scan and transrectal ultrasound examination, the patients were diagnosed with T3-T4 or N + rectal cancers without distant metastases. The ages were less than or equal to 75 years and the tumor was within 16 cm from the anus. The patients underwent no prior chemotherapy or radiotherapy. The patients received fluorouracil at a dose of 1000 mg/m² daily during synchronous chemoradiation, and the intravenous infusion was continuously carried out for 1–5 days. At the first week and the fifth week after the start of radiotherapy, the consolidation chemotherapy regimen was that the fluorouracil was administered at a dose of 500 mg/m² daily, and the intravenous infusion was continuously carried out for 1–5 days, with 4 weeks as a period, and there were a total of four periods. The radiotherapy was the whole pelvic irradiation. The total dose was 50.4Gy (1.8Gy each time, a total of 28 times), and the local supplement dose in the postoperative radiotherapy group was 5.4Gy. Finally, 799 patients were randomly divided into two groups: the preoperative chemoradiotherapy group and the postoperative chemoradiation group. The local recurrence rate was significantly reduced in the preoperative chemoradiation group (6%, 13%; P = 0.006); after examination by the surgeon, it was considered that a total of 194 patients needed to undergo abdominal perineal resection (the anal sphincter cannot be preserved) before surgery. The actual anal sphincter preservation rates in two groups were 39% and 19%, respectively (P = 0.004), and the anal sphincter preservation rate in the preoperative synchronous chemoradiation group was significantly increased. It was important that the acute and long-term side effects of the preoperative synchronous chemoradiation group were significantly lower than that of the postoperative synchronous chemoradiation group, and the incidences of anastomotic leakage, bleeding, and intestinal obstruction were not increased in the preoperative synchronous chemoradiation group. Although its delayed wound healing rate was higher than that of the postoperative synchronous chemoradiation group, the difference did not reach statistical significance.

The best timing for preoperative radiotherapy is an issue of concern to clinical oncologists, who can get tips from the abovementioned laboratory studies on the mechanism underlying the effect of radioactive damage on tissue healing. The radiotherapy given at a 3–6-week interval is safe, because early phase reaction of the radiotherapy has subsided at this moment and the late phase microvascular injury and fibrosis have not occurred. By this time, the incidence of postoperative complications caused by radiotherapy is lower, which has been verified in our long-term clinical practice.