Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study

Hikasa, Yukiko; Suzuki, Satoshi; Mihara, Yuko; Tanabe, Satoshi; Shirakawa, Yasuhiro; Fujiwara, Toshiyoshi; Morimatsu, Hiroshi

doi:10.1007/s00540-020-02766-y

Cited by 12 publications

(10 citation statements)

References 39 publications

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“…The composite of postoperative complications occurred in nearly 40% of elderly patients, which is consistent with the result from Hikasa et al (4). Among these complications, pulmonary complications, myocardial injury and anastomotic leakage constituted the most common complications after minimally invasive esophagectomy in this trial, in line with previous reports (16)(17)(18).…”

Section: Discussionsupporting

confidence: 92%

“…The morbidity rate and 30-day mortality rate were reported to be up to 64% and 5%, respectively ( 2 , 3 ). Despite the use of minimally invasive techniques and well-controlled anesthesia, the incidence of postoperative complications remains high, reaching approximately one thirds ( 4 , 5 ). Postoperative complications increase health care costs and extend the length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

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Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial

Tang

Qiu

et al. 2021

Front. Surg.

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Study Objective: This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care.Design: A prospective, randomized, controlled study.Setting: A single tertiary care center with a study period from November 2017 to December 2018.Patients: Patients over 65 years old who were scheduled for elective MIE.Interventions: The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped.Measurements: The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality.Main Results: Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, P = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, P = 0.92). Compared with those in the control group (n = 32), patients in the GDT group (n = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, P <0.05) and less crystalloid fluid (1,318 ± 386 vs. 1,937 ± 334 ml, P <0.05).Conclusion: The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients.Clinical Trial Number and Registry URL: ChiCTR-INR-17013352; http://www.chictr.org.cn/showproj.aspx?proj=22883

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial

Tang

Qiu

et al. 2021

Front. Surg.

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“…Two studies including patients undergoing minimally invasive lobectomy [26] and open thoracotomy [27] figured out that both restrictive and liberal intraoperative fluid administration were related to adverse effects on postoperative outcomes. Meanwhile, a recent study reported a greater intraoperative positive fluid balance was independently associated with a higher incidence of complications including VTE [28]. Moreover, the fluid volume varied greatly in different studies, Kim et al [27] study suggested intraoperative net fluid infusion at 4-5 ml/kg/h with better results while Wu et al [26] suggested moderate fluid infusion at greater than 9.4 ml/kg/h and less than 11.8 ml/kg/h.…”

Section: Discussionmentioning

confidence: 99%

Risk factors and potential predictors of pulmonary embolism in cancer patients undergoing thoracic and abdominopelvic surgery: a case control study

Liu

Chen

et al. 2022

Thrombosis J

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Background Postoperative pulmonary embolism (PE) is a severe complication leading to death and poor prognosis. The present study investigated the risk factors and potential predictors of PE in cancer patients undergoing thoracic and abdominopelvic surgery. Methods A retrospective study was conducted on the patients with cancer who underwent thoracic and abdominopelvic surgery in Sichuan Cancer Hospital from December 2016 to January 2022. A total of 189 patients were included, in which 63 patients diagnosed PE after operation were collected as PE group, and 126 patients matched by age, type of cancer and cancer location were enrolled as control group. Conditional logistic regression was conducted to analyze the association between PE and risk factors. Predictive values of key factors were compared by the area under the curve (AUC) in receiver operating characteristic curve (ROC) curve. Results Conditional multivariate logistic regression showed that BMI (odds ratio [OR] 4.065, 95% confidence interval [CI] 1.138–14.527; p = 0.031), intraoperative hypotension time (OR 4.095, 95% CI 1.367–12.266; p = 0.009), same day fluid balance (OR 0.245, 95% CI 0.061–0.684; p = 0.048), and postoperative D-Dimer (OR 1.693, 95% CI 1.098–2.611; p = 0.017) were significantly related to the occurrence of postoperative PE. Postoperative D-Dimer had the maximal AUC value 0.8014 (95% CI: 0.7260–0.8770) for predicting PE, with a cutoff value of 1.505 μg/ml. Conclusions BMI, intraoperative hypotension time, lower same day fluid balance and postoperative D-dimer are independent risk factors associated with PE in cancer patients undergoing thoracic and abdominopelvic surgery. Postoperative D-Dimer seems to be a good indicator to predict postoperative PE for cancer patients.

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“…In this study, patients in the GDFT group received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h, P = 0.013), while fluid loss was similar between the two groups (6.9 vs. 7.1 ml/kg/h, P = 0.691). A larger amount of fluid was infused in our group of patients compared with the other types of surgery including laparoscopic gastric bypass surgery ( 7 ), colorectal surgery ( 8 ), and esophageal surgery ( 9 ). Even compared with patients undergoing other open abdominal surgeries (including visceral, vascular, and urology surgeries) receiving goal-directed fluid therapy ( 10 ), patients in our study received more fluids intraoperatively (15.8 vs. 10.8 ml/kg/h).…”

Section: Discussionmentioning

confidence: 99%

Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study

Che

Zhu

et al. 2022

Front. Oncol.

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BackgroundFluid management during major gynecologic oncology surgeries faces great challenges due to the distinctive characteristics of patients with gynecologic malignancies as well as features of the surgical procedure. Intraoperative goal-directed fluid therapy (GDFT) has been proven to be effective in reducing postoperative complications among major colorectal surgeries; however, the efficacy of GDFT has not been fully studied in gynecologic malignancy surgeries. This study aimed to discuss the influence of GDFT practice in patients undergoing major gynecologic oncology surgery.MethodsThis study was a controlled before-and-after study. From June 2015 to June 2018 in Peking Union Medical College Hospital, a total of 300 patients scheduled for elective laparotomy of gynecological malignancies were enrolled and chronologically allocated into two groups, with the earlier 150 patients in the control group and the latter 150 patients in the GDFT group. The GDFT protocol was applied by Vigileo/FloTrac monitoring of stroke volume and fluid responsiveness to guide intraoperative fluid infusion and the use of vasoactive agents. The primary outcome was postoperative complications within 30 days after surgery. The secondary outcome included length of stay and time of functional recovery.ResultsA total of 249 patients undergoing major gynecologic oncology surgery were analyzed in the study, with 129 in the control group and 120 patients in the GDFT group. Patients in the GDFT group had higher ASA classifications and more baseline comorbidities. GDFT patients received significantly less fluid infusion than the control group (15.8 vs. 17.9 ml/kg/h), while fluid loss was similar (6.9 vs. 7.1 ml/kg/h). GDFT was associated with decreased risk of postoperative complications (OR = 0.572, 95% CI 0.343 to 0.953, P = 0.032), especially surgical site infections (OR = 0.127, 95% CI 0.003 to 0.971, P = 0.037). The postoperative bowel function recovery and length of hospital stay were not significantly different between the two groups.ConclusionGoal-directed intraoperative fluid therapy is associated with fewer postoperative complications in patients undergoing major gynecologic oncology surgery.

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Intraoperative fluid therapy and postoperative complications during minimally invasive esophagectomy for esophageal cancer: a single-center retrospective study

Cited by 12 publications

References 39 publications

Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial

Stroke Volume Variation-Guided Goal-Directed Fluid Therapy Did Not Significantly Reduce the Incidence of Early Postoperative Complications in Elderly Patients Undergoing Minimally Invasive Esophagectomy: A Randomized Controlled Trial

Risk factors and potential predictors of pulmonary embolism in cancer patients undergoing thoracic and abdominopelvic surgery: a case control study

Goal-Directed Intraoperative Fluid Therapy Benefits Patients Undergoing Major Gynecologic Oncology Surgery: A Controlled Before-and-After Study

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