Jin Zhaosheng, Razak Alina, Huang Huang, Muthukumar Arun, Murphy Jasper, Shteynman Lana, Bergese Sergio D, Gan Tong J
From the Department of Anesthesiology, Stony Brook University Medicine Center, Stony Brook, New York.
Division of Anesthesiology, Critical Care and Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas.
Anesth Analg. 2025 Apr 1;140(4):821-832. doi: 10.1213/ANE.0000000000007277. Epub 2024 Nov 13.
Surgery is the first-line curative treatment for most solid-organ malignancies. During major surgeries, fluid under- or over administration can have a significant impact on recovery and postoperative outcomes. For patients undergoing oncologic surgery, delayed recovery or complications could additionally impact subsequent oncologic treatment planning. This systematic review and meta-analysis aims to evaluate the impact of goal-directed fluid therapy (GDFT) on perioperative outcomes after oncologic surgeries.
We systematically searched PubMed, EMBASE, CINAHL, and Web of Science citation index for clinical trials comparing the GDFT to routine clinical care. The primary outcomes of interest are the hospital length of stay and the total incidence of postoperative complications. Secondary outcomes include organ-specific complications and recovery of bowel function.
The literature search was last updated on February 17, 2024. We identified a total of 24 randomized controlled trials (RCTs) comparing GDFT to routine care with 1172 and 1186 patients, respectively. The GDFT arm had a significantly shorter length of hospital stay (mean difference [MD], 1.57 days, 95% confidence interval [CI], -2.29 to -0.85, P < .01), as well as lower incidence of complications (risk ratio, 0.74, 95% CI, 0.56-0.97, P = .03). The GDFT arm also had a shorter time to bowel function recovery (MD, 0.58 days, 95% CI, -1.02 to -0.14, P = .01). None of the included trials reported the longer-term oncologic outcomes. The overall certainty of evidence is low due to between-study variance and study risk of bias. Trial sequence analysis indicates that further studies are unlikely to alter the conclusion regarding postoperative length of stay but may provide further information on the postoperative complications.
Our systematic review and meta-analysis suggests that in oncologic surgery, intraoperative GDFT significantly reduces the length of hospital stay, lowers the risk of complications, and facilitates bowel function recovery. Further studies are required to evaluate whether the improvement in early postoperative outcomes leads to better long-term oncologic outcomes.
手术是大多数实体器官恶性肿瘤的一线治愈性治疗方法。在大型手术期间，液体输注不足或过量都会对恢复和术后结果产生重大影响。对于接受肿瘤手术的患者，恢复延迟或并发症可能会额外影响后续的肿瘤治疗计划。本系统评价和荟萃分析旨在评估目标导向液体治疗（GDFT）对肿瘤手术后围手术期结局的影响。
我们系统检索了PubMed、EMBASE、CINAHL和科学引文索引数据库，以查找比较GDFT与常规临床护理的临床试验。感兴趣的主要结局是住院时间和术后并发症的总发生率。次要结局包括器官特异性并发症和肠功能恢复情况。
文献检索于2024年2月17日最后更新。我们共纳入24项随机对照试验（RCT），分别比较了GDFT组和常规护理组，每组患者分别为1172例和1186例。GDFT组的住院时间显著缩短（平均差[MD]为1.57天，95%置信区间[CI]为-2.29至-0.85，P < 0.01），并发症发生率也较低（风险比为0.74，95%CI为0.56 - 0.97，P = 0.03）。GDFT组的肠功能恢复时间也较短（MD为0.58天，95%CI为-1.02至-0.14，P = 0.01）。纳入的试验均未报告长期肿瘤学结局。由于研究间的异质性和研究偏倚风险，证据的总体确定性较低。试验序贯分析表明，进一步的研究不太可能改变关于术后住院时间的结论，但可能会提供关于术后并发症的更多信息。
我们的系统评价和荟萃分析表明，在肿瘤手术中，术中GDFT可显著缩短住院时间，降低并发症风险，并促进肠功能恢复。需要进一步研究来评估术后早期结局的改善是否会带来更好的长期肿瘤学结局。
