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Erschienen in: Journal of Gastrointestinal Surgery 12/2018

31.07.2018 | Original Article

Clinical Implications of Intraoperative Fluid Therapy in Pancreatic Surgery

verfasst von: Stefano Andrianello, Giovanni Marchegiani, Elisa Bannone, Gaia Masini, Giuseppe Malleo, Gabriele L Montemezzi, Enrico Polati, Claudio Bassi, Roberto Salvia

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 12/2018

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Abstract

Background

Recent studies have suggested that intraoperative fluid overload is associated with a worse outcome after major abdominal surgery. However, evidence in the field of pancreatic surgery is still not consistent. The aim of this study was to evaluate whether intraoperative fluid management could affect the outcome of a major pancreatic resection.

Methods

Prospective analysis of 350 major pancreatic resections performed in 2016 at the Department of General and Pancreatic Surgery—The Pancreas Institute, University of Verona Hospital Trust. Patients were dichotomized according to intraoperative fluid volume administration (near-zero vs. liberal fluid balance) and matched using propensity score. Intraoperative fluid administration was then correlated to the postoperative outcome.

Results

Liberal fluid balance was associated with an increased rate of Clavien-Dindo ≥ IIIB both after pancreaticoduodenectomy (60.3 vs. 30.2%, p < 0.01) and distal pancreatectomy (50 vs. 27.1%, p = 0.03). In case of pancreaticoduodenectomy, liberal fluid balance was also associated with an increased rate of pancreatic fistula (33.3 vs. 19.9%, p = 0.05), but when considering patients with soft remnants, an increase rate of pancreatic fistula (52.8 vs. 23%, p = 0.03) was indeed associated with the near-zero fluid balance.

Conclusion

Considering all pancreatic resections, a liberal fluid balance is associated with an increased rate of postoperative morbidity. However, in the case of PD with a soft pancreas, an NZF balance could lead to pancreatic stump ischemia and anastomotic failure. Intraoperative fluid management should be managed according to patient’s pancreas-specific risk factors.
Literatur
1.
Zurück zum Zitat Bassi C, Andrianello S. Identifying key outcome metrics in pancreatic surgery, and how to optimally achieve them. HPB. 2017;19(3):178–181CrossRef Bassi C, Andrianello S. Identifying key outcome metrics in pancreatic surgery, and how to optimally achieve them. HPB. 2017;19(3):178–181CrossRef
2.
Zurück zum Zitat Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–591.CrossRef Bassi C, Marchegiani G, Dervenis C, et al. The 2016 update of the International Study Group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery. 2017;161:584–591.CrossRef
3.
Zurück zum Zitat Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth. 2015;62:158–168.CrossRef Miller TE, Roche AM, Mythen M. Fluid management and goal-directed therapy as an adjunct to Enhanced Recovery After Surgery (ERAS). Can J Anaesth. 2015;62:158–168.CrossRef
4.
Zurück zum Zitat Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.CrossRef Brandstrup B, Tønnesen H, Beier-Holgersen R, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.CrossRef
5.
Zurück zum Zitat Nisanevich V, Felsenstein I, Almogy G, et al. Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery. Anesthesiology. 2005;103:25–32.CrossRef Nisanevich V, Felsenstein I, Almogy G, et al. Effect of Intraoperative Fluid Management on Outcome after Intraabdominal Surgery. Anesthesiology. 2005;103:25–32.CrossRef
6.
Zurück zum Zitat Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004;240:892–9.CrossRef Holte K, Klarskov B, Christensen DS, et al. Liberal versus restrictive fluid administration to improve recovery after laparoscopic cholecystectomy: a randomized, double-blind study. Ann Surg. 2004;240:892–9.CrossRef
7.
Zurück zum Zitat Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: A randomised controlled trial. Lancet. 2002;359:1812–1818.CrossRef Lobo DN, Bostock KA, Neal KR, et al. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: A randomised controlled trial. Lancet. 2002;359:1812–1818.CrossRef
8.
Zurück zum Zitat Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. British Journal of Anaesthesia. 2002;89:622–632.CrossRef Holte K, Sharrock NE, Kehlet H. Pathophysiology and clinical implications of perioperative fluid excess. British Journal of Anaesthesia. 2002;89:622–632.CrossRef
9.
Zurück zum Zitat Harnoss JC, Ulrich AB, Harnoss JM, et al. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery. 2014;155:47–57.CrossRef Harnoss JC, Ulrich AB, Harnoss JM, et al. Use and results of consensus definitions in pancreatic surgery: a systematic review. Surgery. 2014;155:47–57.CrossRef
10.
Zurück zum Zitat McMillan MT, Allegrini V, Asbun HJ, et al. Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy. Ann Surg. 2017;265:978–986.CrossRef McMillan MT, Allegrini V, Asbun HJ, et al. Incorporation of Procedure-specific Risk Into the ACS-NSQIP Surgical Risk Calculator Improves the Prediction of Morbidity and Mortality After Pancreatoduodenectomy. Ann Surg. 2017;265:978–986.CrossRef
11.
Zurück zum Zitat Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–2137.CrossRef Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364:2128–2137.CrossRef
12.
Zurück zum Zitat Weinberg L, Wong D, Karalapillai D, et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure). BMC Anesthesiol. 2014;14:35.CrossRef Weinberg L, Wong D, Karalapillai D, et al. The impact of fluid intervention on complications and length of hospital stay after pancreaticoduodenectomy (Whipple’s procedure). BMC Anesthesiol. 2014;14:35.CrossRef
13.
Zurück zum Zitat Behman R, Hanna S, Coburn N, et al. Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy. Am J Surg. 2015;210:896–903.CrossRef Behman R, Hanna S, Coburn N, et al. Impact of fluid resuscitation on major adverse events following pancreaticoduodenectomy. Am J Surg. 2015;210:896–903.CrossRef
14.
Zurück zum Zitat Kratz T, Simon C, Fendrich V, et al. Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients. Technol Health Care. 2016;24(6):899–907. CrossRef Kratz T, Simon C, Fendrich V, et al. Implementation and effects of pulse-contour- automated SVV/CI guided goal directed fluid therapy algorithm for the routine management of pancreatic surgery patients. Technol Health Care. 2016;24(6):899–907. CrossRef
15.
Zurück zum Zitat Weinberg L, Ianno D, Churilov L, et al. Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial. PLoS One. 2017;12(9):e0183313. CrossRef Weinberg L, Ianno D, Churilov L, et al. Restrictive intraoperative fluid optimisation algorithm improves outcomes in patients undergoing pancreaticoduodenectomy: A prospective multicentre randomized controlled trial. PLoS One. 2017;12(9):e0183313. CrossRef
16.
Zurück zum Zitat Lindenblatt N, Park S, Alsfasser G, et al. [Intraoperative fluid management in pancreatic resections--the surgeon’s view]. Zentralbl Chir. 2008;133:168–75.CrossRef Lindenblatt N, Park S, Alsfasser G, et al. [Intraoperative fluid management in pancreatic resections--the surgeon’s view]. Zentralbl Chir. 2008;133:168–75.CrossRef
17.
Zurück zum Zitat Melis M, Marcon F, Masi A, et al. Effect of intra-operative fluid volume on peri-operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol. 2012;105:81–84.CrossRef Melis M, Marcon F, Masi A, et al. Effect of intra-operative fluid volume on peri-operative outcomes after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Surg Oncol. 2012;105:81–84.CrossRef
18.
Zurück zum Zitat Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216:1–14.CrossRef Callery MP, Pratt WB, Kent TS, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216:1–14.CrossRef
19.
Zurück zum Zitat Lassen K, Coolsen MME, Slim K, et al. Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2013;37(2):240–58.CrossRef Lassen K, Coolsen MME, Slim K, et al. Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations. World J Surg. 2013;37(2):240–58.CrossRef
20.
Zurück zum Zitat Bassi C, Falconi M, Molinari E, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: Results of a prospective randomized trial. Surgery. 2003;134:766–771.CrossRef Bassi C, Falconi M, Molinari E, et al. Duct-to-mucosa versus end-to-side pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: Results of a prospective randomized trial. Surgery. 2003;134:766–771.CrossRef
21.
Zurück zum Zitat Melotti G, Butturini G, Piccoli M, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg. 2007;246:77–82.CrossRef Melotti G, Butturini G, Piccoli M, et al. Laparoscopic distal pancreatectomy: results on a consecutive series of 58 patients. Ann Surg. 2007;246:77–82.CrossRef
22.
Zurück zum Zitat Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.CrossRef Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007;142(5):761–8.CrossRef
23.
Zurück zum Zitat Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRef Wente MN, Veit JA, Bassi C, et al. Postpancreatectomy hemorrhage (PPH): An International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007;142(1):20–5.CrossRef
24.
Zurück zum Zitat Connor S. Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection. HPB (Oxford). 2016;18:642–651.CrossRef Connor S. Defining post-operative pancreatitis as a new pancreatic specific complication following pancreatic resection. HPB (Oxford). 2016;18:642–651.CrossRef
25.
Zurück zum Zitat Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - J Am Med Assoc. 2016;315:762–774.CrossRef Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA - J Am Med Assoc. 2016;315:762–774.CrossRef
26.
Zurück zum Zitat Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240:205–213.CrossRef Dindo D, Demartines N, Clavien P-A. Classification of Surgical Complications. A New Proposal With Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surg. 2004;240:205–213.CrossRef
27.
Zurück zum Zitat Cuthbertson CM, Christophi C. Disturbances of the microcirculation in acute pancreatitis. Br J Surg. 2006;93:518–530.CrossRef Cuthbertson CM, Christophi C. Disturbances of the microcirculation in acute pancreatitis. Br J Surg. 2006;93:518–530.CrossRef
28.
Zurück zum Zitat Palani Velu LK, Chandrabalan V V., Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB. 2014;16:610–619.CrossRef Palani Velu LK, Chandrabalan V V., Jabbar S, et al. Serum amylase on the night of surgery predicts clinically significant pancreatic fistula after pancreaticoduodenectomy. HPB. 2014;16:610–619.CrossRef
29.
Zurück zum Zitat Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg. 2016;103:553–563.CrossRef Palani Velu LK, McKay CJ, Carter CR, et al. Serum amylase and C-reactive protein in risk stratification of pancreas-specific complications after pancreaticoduodenectomy. Br J Surg. 2016;103:553–563.CrossRef
30.
Zurück zum Zitat Eng OS, Goswami J, Moore D, et al. Intraoperative fluid administration is associated with perioperative outcomes in pancreaticoduodenectomy: a single center retrospective analysis. J Surg Oncol. 2013;108:242–247.CrossRef Eng OS, Goswami J, Moore D, et al. Intraoperative fluid administration is associated with perioperative outcomes in pancreaticoduodenectomy: a single center retrospective analysis. J Surg Oncol. 2013;108:242–247.CrossRef
31.
Zurück zum Zitat Van Samkar G, Eshuis WJ, Bennink RJ, et al. Intraoperative fluid restriction in pancreatic surgery: A double blinded randomised controlled trial. PLoS One. 2015;10(10):e0140294CrossRef Van Samkar G, Eshuis WJ, Bennink RJ, et al. Intraoperative fluid restriction in pancreatic surgery: A double blinded randomised controlled trial. PLoS One. 2015;10(10):e0140294CrossRef
32.
Zurück zum Zitat Wang S, Wang X, Dai H, et al. The Effect of Intraoperative Fluid Volume Administration on Pancreatic Fistulas after Pancreaticoduodenectomy. J Investig Surg. 2014;27:88–94.CrossRef Wang S, Wang X, Dai H, et al. The Effect of Intraoperative Fluid Volume Administration on Pancreatic Fistulas after Pancreaticoduodenectomy. J Investig Surg. 2014;27:88–94.CrossRef
33.
Zurück zum Zitat Grant F, Brennan MF, Allen PJ, et al. Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy. Ann Surg. 2016;264:591–598.CrossRef Grant F, Brennan MF, Allen PJ, et al. Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy. Ann Surg. 2016;264:591–598.CrossRef
34.
Zurück zum Zitat Han IW, Kim H, Heo J, et al. Excess intraoperative fluid volume administration is associated with pancreatic fistula after pancreaticoduodenectomy. Medicine (Baltimore). 2017;96:e6893.CrossRef Han IW, Kim H, Heo J, et al. Excess intraoperative fluid volume administration is associated with pancreatic fistula after pancreaticoduodenectomy. Medicine (Baltimore). 2017;96:e6893.CrossRef
35.
Zurück zum Zitat Huang Y, Chua TC, Gill AJ, et al. Impact of perioperative fluid administration on early outcomes after pancreatoduodenectomy: A meta-analysis. Pancreatology. 2017;17:334–341.CrossRef Huang Y, Chua TC, Gill AJ, et al. Impact of perioperative fluid administration on early outcomes after pancreatoduodenectomy: A meta-analysis. Pancreatology. 2017;17:334–341.CrossRef
36.
Zurück zum Zitat Wang GS, Dong M, Sheng WW, et al. [Preoperative restricted versus liberal fluid administration on perioperative safety for pancreatic surgery: a Meta-analysis]. Zhonghua Wai Ke Za Zhi. 2017;55:618–625.PubMed Wang GS, Dong M, Sheng WW, et al. [Preoperative restricted versus liberal fluid administration on perioperative safety for pancreatic surgery: a Meta-analysis]. Zhonghua Wai Ke Za Zhi. 2017;55:618–625.PubMed
37.
Zurück zum Zitat Strasberg SM, Drebin JA, Mokadam NA, Green DW JK, JP E. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg. 2002;194:746–758.CrossRef Strasberg SM, Drebin JA, Mokadam NA, Green DW JK, JP E. Prospective trial of a blood supply-based technique of pancreaticojejunostomy: effect on anastomotic failure in the Whipple procedure. J Am Coll Surg. 2002;194:746–758.CrossRef
Metadaten
Titel
Clinical Implications of Intraoperative Fluid Therapy in Pancreatic Surgery
verfasst von
Stefano Andrianello
Giovanni Marchegiani
Elisa Bannone
Gaia Masini
Giuseppe Malleo
Gabriele L Montemezzi
Enrico Polati
Claudio Bassi
Roberto Salvia
Publikationsdatum
31.07.2018
Verlag
Springer US
Erschienen in
Journal of Gastrointestinal Surgery / Ausgabe 12/2018
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-018-3887-6

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