The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer

Kubo, Yuto; Yamasaki, Makoto; Yamashita, Kotaro; Makino, Tomoki; Saito, Takuro; Yamamoto, Keiji; Takahashi, Tsuyoshi; Kurokawa, Yukinori; Motoori, Masaaki; Kimura, Yutaka; Nakajima, Kiyokazu; Eguchi, Hidetoshi; Doki, Yuichiro

doi:10.3390/jcm11113219

Cited by 10 publications

(11 citation statements)

References 39 publications

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“…Both cumulative fluid balance in the first 48 h and fluid balance of > 3000 ml on postoperative day one have been implicated as causative factors for PPC and anastomotic leak in esophagectomies. Authors report fewer complications following the adoption of an anesthetic regimen with optimal intravenous fluids [11, 26–28]. In our patient population, the ERP group reported the use of significantly fewer intravenous fluids during surgery (2.25 L vs 3.5 L, p < 0.0001) as well as on the first postoperative day (2.1 L vs 3.1 L, p < 0.0001) compared to the PP group.…”

Section: Discussionmentioning

confidence: 64%

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Impact of Enhanced Recovery Protocols on Short‐Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India

Ramakrishnan,

Saini,

Arora

et al. 2023

World j. surg.

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Objective Surgery for esophageal cancer is associated with high mortality and morbidity, especially in low and middle-income countries. The recent enhanced recovery after surgery guidelines for esophagectomy (2018) which attempt to reduce complications and length of stay (LOS) have rarely been validated in these settings. This study aimed to analyse the effect of this protocol on short-term outcomes in our subset of patients. Methods A retrospective review was conducted to investigate the outcomes of enhanced recovery protocol (ERP) compared to standard pre-protocol care (PP) in patients who underwent esophagectomy for cancer (31 in ERP vs 61 in PP group) at Cancer Research Institute, Uttarakhand, India. The main outcomes measured were 30-day mortality, morbidity and LOS. Risk assessment was stratified as per Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) systems while complications were classified as per the Clavien-Dindo scale. Results Preoperative clinical characteristics were similar between groups. Though the predicted POSSUM mortality and morbidity were significantly higher in the ERP group (p = 0.007), 30-day morbidity (19.35% vs 42.62%, p = 0.027) as well as median LOS (12 vs 15 days, p \ 0.001) was significantly lower in ERP group. The PP group reported 4 deaths within 30 days as compared to none in the ERP group (p = 0.296). Furthermore, the ERP group reported lower occurrence of pulmonary complications (6.4%vs24.6%,p = 0.046), hemodynamic instability (0%vs14.75%,p = 0.026) as well as need for prolonged postoperative ventilation ([ 24 h; 0% vs 11.48%, p = 0.004). Both minor and major complications as assessed by the Clavien-Dindo scale were lower in the group ERP though these differences were not statistically significant (0.059). Conclusions Implementation of ERP improved short-term outcomes; hence can be strongly recommended in patients undergoing esophagectomy.

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Section: Discussionmentioning

confidence: 64%

“…Esophagectomy for cancer has a higher incidence of complications as compared to other GI cancers with pneumonia (29%) and anastomotic leak (19%) being the most common [11]. Mortality post-surgery has been reported to be as high as 14% at 90 days with LMIC reporting significantly higher rates [2].…”

Section: Discussionmentioning

confidence: 99%

Impact of Enhanced Recovery Protocols on Short‐Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India

Ramakrishnan,

Saini,

Arora

et al. 2023

World j. surg.

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“…In the present study, the cumulative fluid balance on POD1 was significantly lower in the ERAS group than in the control group. In the study from Japan, positive fluid balance higher than 3,000 mL at POD 1 had a significantly negative impact on anastomotic leakage and postoperative pneumonia ( 21 ). Besides intraoperative GDT, this might be another explanation of why patients in the ERAS group experienced less postoperative interstitial pulmonary edema and major morbidity.…”

Section: Discussionmentioning

confidence: 99%

Impact of fluid balance and opioid-sparing anesthesia within enchanced recovery pathway on postoperative morbidity after transthoracic esophagectomy for cancer

Djukanovic,

Skrobic,

Stojakov

et al. 2024

Front. Med.

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BackgroundEnhanced Recovery After Surgery (ERAS) protocol for esophagectomy may reduce the high incidence of postoperative morbidity and mortality. The aim of this study was to assess the impact of properly conducted ERAS protocol with specific emphasis on fluid balance and opioid-sparing anesthesia (OSA) on postoperative major morbidity and mortality after esophagectomy.MethodsPatients undergoing elective esophagectomy for esophageal cancer at the Hospital for Digestive Surgery, University Clinical Center of Serbia, from December 2017 to March 2021, were included in this retrospective observational study. Patients were divided into two groups: the ERAS group (OSA, intraoperative goal-directed therapy, and postoperative “near-zero” fluid balance) and the control group (opioid-based anesthesia, maintenance mean blood pressure ≥ 65 mmHg, and liberal postoperative fluid management). The primary outcome was major morbidity within 30 days from surgery and 30-day and 90-day mortality. Multivariable analysis was used to examine the effect of the ERAS protocol.ResultsA total of 121 patients were divided into the ERAS group (69 patients) and the control group (52 patients). Patients in the ERAS group was received less fentanyl, median 300 (interquartile range (IQR), 200–1,550) mcg than in control group, median 1,100 (IQR, 650–1750) mcg, p < 0.001. Median intraoperative total infusion was lower in the ERAS group, 2000 (IQR, 1000–3,750) mL compared to control group, 3,500 (IQR, 2000–5,500) mL, p < 0.001. However, intraoperative norepinephrine infusion was more administered in the ERAS group (52.2% vs. 7.7%, p < 0.001). On postoperative day 1, median cumulative fluid balance was 2,215 (IQR, −150-5880) mL in the ERAS group vs. 4692.5 (IQR, 1770–10,060) mL in the control group, p = 0.002. After the implementation of the ERAS protocol, major morbidity was less frequent in the ERAS group than in the control group (18.8% vs. 75%, p < 0.001). There was no statistical significant difference in 30-day and 90-day mortality (p = 0.07 and p = 0.119, respectively). The probability of postoperative major morbidity and interstitial pulmonary edema were higher in control group (OR 5.637; CI95%:1.178–10.98; p = 0.030 and OR 5.955; CI95% 1.702–9.084; p < 0.001, respectively).ConclusionA major morbidity and interstitial pulmonary edema after esophagectomy were decreased after the implementation of the ERAS protocol, without impact on overall mortality.

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“…According to the Esophageal Complications Consensus Group, the most common complication after esophagectomy for esophageal cancer is pneumonia (29%), followed by anastomotic leakage (19%) [ 17 ], which is consistent with our findings. Kubo et al assessed the impact of perioperative fluid balance on postoperative complications following MIE for esophageal cancer and reported that acute pneumonia within 7 postoperative days as well as anastomotic leakage were more common in patients with a fluid balance > 3,000 mL on POD 1 but not in patients with a positive fluid balance on the day of surgery [ 18 ]. In this previous study, the higher fluid balance group was defined by a fluid balance > 3,000 mL, which is much less than the previously reported fluid balance of 6,900–7,873 mL in patients undergoing right-sided thoracotomy [ 5 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this previous study, the higher fluid balance group was defined by a fluid balance > 3,000 mL, which is much less than the previously reported fluid balance of 6,900–7,873 mL in patients undergoing right-sided thoracotomy [ 5 , 8 ]. This indicates that the fluid volume should be strictly controlled on the first POD [ 18 ]. Hikasa et al examined the association between fluid balance and postoperative complications in MIE [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of intraoperative fluid management on postoperative complications in patients undergoing minimally invasive esophagectomy for esophageal cancer: a retrospective single-center study

Takahashi,

Toyama,

Takahashi

et al. 2024

BMC Anesthesiol

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Background Esophagectomy is a high-risk procedure that can involve serious postoperative complications. There has been an increase in the number of minimally invasive esophagectomies (MIEs) being performed. However, the relationship between intraoperative management and postoperative complications in MIE remains unclear. Methods After the institutional review board approval, we enrolled 300 patients who underwent MIE at Tohoku University Hospital between April 2016 and March 2021. The relationships among patient characteristics, intraoperative and perioperative factors, and postoperative complications were retrospectively analyzed. The primary outcome was the relationship between intraoperative fluid volume and anastomotic leakage, and the secondary outcomes included the associations between other perioperative factors and postoperative complications. Results Among 300 patients, 28 were excluded because of missing data; accordingly, 272 patients were included in the final analysis. The median [interquartile range] operative duration was 599 [545–682] minutes; total intraoperative infusion volume was 3,747 [3,038–4,399] mL; total infusion volume per body weight per hour was 5.48 [4.42–6.73] mL/kg/h; and fluid balance was + 2,648 [2,015–3,263] mL. The postoperative complications included anastomotic leakage in 68 (25%) patients, recurrent nerve palsy in 91 (33%) patients, pneumonia in 62 (23%) patients, cardiac arrhythmia in 13 (5%) patients, acute kidney injury in 5 (2%) patients, and heart failure in 5 (2%) patients. The Cochrane-Armitage trend test indicated significantly increased anastomotic leakage among patients with a relatively high total infusion volume (P = 0.0085). Moreover, anastomotic leakage was associated with male sex but not with peak serum lactate levels. Patients with a longer anesthesia duration or recurrent nerve palsy had a significantly higher incidence of postoperative pneumonia than those without. Further, the incidence of postoperative pneumonia was not associated with the operative duration, total infusion volume, or fluid balance. The operative duration and blood loss were related to the total infusion volume. Acute kidney injury was not associated with the total infusion volume or serum lactate levels. Conclusions Among patients who underwent MIE, the total infusion volume was positively correlated with the incidence of anastomotic leakage. Further, postoperative pneumonia was associated with recurrent nerve palsy but not total infusion volume or fluid balance.

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The Impact of Perioperative Fluid Balance on Postoperative Complications after Esophagectomy for Esophageal Cancer

Cited by 10 publications

References 39 publications

Impact of Enhanced Recovery Protocols on Short‐Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India

Impact of Enhanced Recovery Protocols on Short‐Term Outcomes in Esophagectomy: A Retrospective Cohort Study from Cancer Research Institute, Uttarakhand, India

Impact of fluid balance and opioid-sparing anesthesia within enchanced recovery pathway on postoperative morbidity after transthoracic esophagectomy for cancer

Impact of intraoperative fluid management on postoperative complications in patients undergoing minimally invasive esophagectomy for esophageal cancer: a retrospective single-center study

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