Division of Surgical Oncology, Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Section of Colon and Rectal Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Ann Surg Oncol. 2019 Feb;26(2):490-496. doi: 10.1245/s10434-018-07092-y. Epub 2018 Dec 4.
Recent data have demonstrated multiple benefits of intra- and postoperative fluid restriction in major abdominal surgery; however, data regarding the outcomes of fluid restriction in cytoreductive surgery and hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) are limited. This study evaluates the safety and short-term clinical outcomes of restricted intraoperative fluid therapy in CRS/HIPEC.
This was a single-institution, retrospective review of all CRS/HIPEC procedures performed at the University of Massachusetts Medical School between January 2009 and July 2017. Recorded variables included demographics, intraoperative factors, 60-day postoperative complications, and length of stay (LOS). Outcomes based on the use of intraoperative permissive fluid therapy (PFT) versus restrictive fluid therapy (RFT) were compared.
Overall, 169 CRS/HIPEC cases were performed during the study period; 84 were managed with PFT and 85 were managed with RFT. No significant differences were identified in patient demographics. There was a decrease in intraoperative administration of crystalloid (8.0 vs. 4.4 L, p < 0.01), colloid (900 vs. 300 mL, p < 0.01), and blood transfusion (0.26 vs. 0.04 units, p < 0.01) in the RFT cohort. LOS was reduced from 11.5 to 9.7 days (p < 0.01) and the incidence of any 60-day complication decreased from 45 to 28% (p = 0.02) in the RFT group. The overall 90-day mortality rate was 0.6% (n = 1). Adjusted logistic regression demonstrated the odds of having a Clavien-Dindo grade III or higher complication was 0.31 (95% confidence interval 0.10-0.95) with RFT.
Intraoperative RFT with standard anesthesia monitoring devices can be safely used in CRS/HIPEC and is associated with a decreased LOS and decreased rate of postoperative complications.
最近的数据表明，在大型腹部手术中，术中及术后液体限制有多种益处；然而，关于细胞减灭术和腹腔热灌注化疗（CRS/HIPEC）中液体限制的结果数据有限。本研究评估了在 CRS/HIPEC 中限制术中液体治疗的安全性和短期临床结果。
这是一项在马萨诸塞大学医学院进行的单中心回顾性研究，纳入了 2009 年 1 月至 2017 年 7 月期间所有进行的 CRS/HIPEC 手术。记录的变量包括人口统计学、术中因素、术后 60 天并发症和住院时间（LOS）。比较了基于术中允许性液体治疗（PFT）与限制性液体治疗（RFT）的结果。
在研究期间共进行了 169 例 CRS/HIPEC 手术；84 例采用 PFT 管理，85 例采用 RFT 管理。患者的人口统计学特征无显著差异。RFT 组术中晶体液（8.0 比 4.4 L，p < 0.01）、胶体液（900 比 300 mL，p < 0.01）和输血（0.26 比 0.04 单位，p < 0.01）的用量减少。RFT 组的 LOS 从 11.5 天缩短至 9.7 天（p < 0.01），术后 60 天并发症的发生率从 45%降至 28%（p = 0.02）。RFT 组总的 90 天死亡率为 0.6%（n = 1）。调整后的 logistic 回归分析显示，使用 RFT 的患者发生 Clavien-Dindo 分级 III 或更高级别并发症的可能性为 0.31（95%置信区间 0.10-0.95）。
在 CRS/HIPEC 中使用标准麻醉监测设备进行术中 RFT 是安全的，与 LOS 缩短和术后并发症发生率降低有关。
