Dataset Information

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

ABSTRACT:

Background

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.

Methods

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.

Results

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 (p = 0.029, p = 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, p = 0.037).

Conclusion

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.

SUBMITTER: Kubo Y

PROVIDER: S-EPMC9181193 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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

Kubo Yuto Y Tanaka Koji K Yamasaki Makoto M Yamashita Kotaro K Makino Tomoki T Saito Takuro T Yamamoto Kazuyoshi K Takahashi Tsuyoshi T Kurokawa Yukinori Y Motoori Masaaki M Kimura Yutaka Y Nakajima Kiyokazu K Eguchi Hidetoshi H Doki Yuichiro Y

Journal of clinical medicine 20220605 11

<h4>Background</h4>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.<h4>Methods</h4>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 b ...[more]

PMID: 35683605

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Project description:Cancer is responsible for approximately 13% of all causes of death worldwide, and 20% of cancer patients die because of malnutrition and its complications. Malnutrition is common in cancer of stomach and esophagus. Although it is widely accepted that malnutrition adversely affects the postoperative outcome of patients, there is little evidence that perioperative nutrition support can reduce surgical risk in malnourished cancer patients. This prospective study was carried out from December 2016 to July 2017 at the Kidwai Memorial Institute of Oncology, Bengaluru. After stratified for age, sex, and tumor localization, patients were selected non-randomly and assigned to study (n = 30, 14 women, 16 men) and control group (n = 30, 14 women, 16 men) as alternate patients. Within 48 h of admission, patients underwent nutritional assessment by the subjective global assessment. Perioperative nutrition was administered in the study group by enteral route only. Patients had a functioning gastrointestinal tract, and they received enteral nutrition (EN). Target intake of non-protein (25 kcal/kg per day) and protein (0.25 g nitrogen/kg per day) was provided using available enteral formulas. This was supplementary to standard hospital diet. Nutritional re-assessment after 15 days of intervention showed significant change in nutritional status, which was measured as gain in weight for each patient. There were significant differences in the mortality and complications between the two groups. The total length of hospitalization and postoperative stay of the control patients were significantly longer than those of the study patients. In conclusion, perioperative nutrition support can decrease the incidence of postoperative complications in moderately and severely malnourished gastric and esophageal cancer patients. In addition, it is effective in reducing mortality. Enteral nutrition support alone can be used in the management of malnourished patients undergoing gastric and esophageal surgery.

Project description:BackgroundOur aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy.MethodsPatients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8-10% during the one lung ventilation (OLV) stage and 8-12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8-12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2).ResultsPatients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C.ConclusionsIn comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients.Trial registrationThis study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598).

Project description:IntroductionEsophagectomy is a key component in the curative treatment of esophageal cancer. Little is understood about the impact of smoking status on perioperative morbidity and mortality and the long-term outcome of patients following esophagectomy.ObjectiveThis study aimed to evaluate morbidity and mortality according to smoking status in patients undergoing esophagectomy for esophageal cancer.MethodsConsecutive patients undergoing two-stage transthoracic esophagectomy (TTE) for esophageal cancers (adenocarcinoma or squamous cell carcinoma) between January 1997 and December 2016 at the Northern Oesophagogastric Unit were included from a prospectively maintained database. The main explanatory variable was smoking status, defined as current smoker, ex-smoker, and non-smoker. The primary outcome was overall survival (OS), while secondary outcomes included perioperative complications (overall, anastomotic leaks, and pulmonary complications) and survival (cancer-specific survival [CSS], recurrence-free survival [RFS]).ResultsDuring the study period, 1168 patients underwent esophagectomy for cancer. Of these, 24% (n = 282) were current smokers and only 30% (n = 356) had never smoked. The median OS of current smokers was significantly shorter than ex-smokers and non-smokers (median 36 vs. 42 vs. 48 months; p = 0.015). However, on adjusted analysis, there was no significant difference in long-term OS between smoking status in the entire cohort. The overall complication rates were significantly higher with current smokers compared with ex-smokers or non-smokers (73% vs. 66% vs. 62%; p = 0.018), and there were no significant differences in anastomotic leaks and pulmonary complications between the groups. On subgroup analysis by receipt of neoadjuvant therapy and tumor histology, smoking status did not impact long-term survival in adjusted multivariable analyses.ConclusionAlthough smoking is associated with higher rates of short-term perioperative morbidity, it does not affect long-term OS, CSS, and RFS following esophagectomy for esophageal cancer. Therefore, implementation of perioperative pathways to optimize patients may help reduce the risk of complications.

Dataset Information

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

Background

Methods

Results

Conclusion

Publications

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

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