Kubo Yuto, Tanaka Koji, Yamasaki Makoto, Yamashita Kotaro, Makino Tomoki, Saito Takuro, Yamamoto Kazuyoshi, Takahashi Tsuyoshi, Kurokawa Yukinori, Motoori Masaaki, Kimura Yutaka, Nakajima Kiyokazu, Eguchi Hidetoshi, Doki Yuichiro
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka 565-0871, Japan.
Department of Surgery, Osaka General Medical Center, Osaka 558-8558, Japan.
J Clin Med. 2022 Jun 5;11(11):3219. doi: 10.3390/jcm11113219.
Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear.
This study included 115 patients with thoracic esophageal squamous cell cancer who underwent MIE between January 2018 and January 2020. We retrospectively evaluated the association between perioperative fluid balance from during surgery to postoperative day (POD) 2, and postoperative complications.
The patients were divided into lower group and higher group based on the median fluid balance during surgery and at POD 1 and POD 2. We found that the higher group at POD 1 (≥3000 mL) was the most important indicator of postoperative complications, such as acute pneumonia within 7 days after surgery, and anastomotic leakage ( = 0.029, = 0.024, respectively). Moreover, the higher group at POD 1 was a significant independent factor for acute postoperative pneumonia by multivariate analysis (OR: 3.270, 95% CI: 1.077-9.929, = 0.037).
This study showed that fluid overload at POD 1 had a negative influence on postoperative complications in patients with esophageal cancer. The fluid balance must be strictly controlled during the early postoperative management of patients undergoing esophageal cancer surgery.
围手术期液体平衡是接受食管癌切除术的食管癌患者管理中的一个重要指标。然而，微创食管癌切除术（MIE）后围手术期液体平衡与术后并发症之间的关联仍不清楚。
本研究纳入了2018年1月至2020年1月期间接受MIE的115例胸段食管鳞状细胞癌患者。我们回顾性评估了从手术期间到术后第2天（POD 2）的围手术期液体平衡与术后并发症之间的关联。
根据手术期间、POD 1和POD 2时的液体平衡中位数，将患者分为较低组和较高组。我们发现，POD 1时的较高组（≥3000 mL）是术后并发症的最重要指标，如术后7天内的急性肺炎和吻合口漏（分别为=0.029，=0.024）。此外，通过多因素分析，POD 1时的较高组是术后急性肺炎的显著独立因素（OR：3.270，95%CI：1.077-9.929，=0.037）。
本研究表明，POD 1时的液体超负荷对食管癌患者的术后并发症有负面影响。在食管癌手术患者的术后早期管理中，必须严格控制液体平衡。
