Fluid administration in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: neither too much nor too little
Administração de fluidos em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica: nem muito nem muito pouco
Maria Elvira Castellanos Garijo; Ana Sepúlveda Blanco; Jose Tinoco Gonzalez; Alicia Merinero Casado; Juan Ignacio Medina de Moya; Gabriel Yanes Vidal; Ana Forastero Rodriguez; Cristobalina Ángeles Martin García; Francisco Cristobal Muñoz-Casares; Javier Padillo Ruiz
Abstract
Introduction
Intraoperative fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy plays an important role in postoperative morbidity. Studies have found an association between overload fluid therapy and increased postoperative complications, advising restrictive intraoperative fluid therapy. Our objective in this study was to compare the morbidity associated with restrictive versus non-restrictive intraoperative fluid therapy.
Methods
Retrospective analysis of a database collected prospectively in the Anesthesiology Service of Virgen del Rocío Hospital, from December 2016 to April 2019. One hundred and six patients who underwent complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy were divided into two cohorts according to Fluid Therapy received 1. Restrictive ≤ 9 mL.kg-1.h-1 (34 patients), 2. Non-restrictive ≥ 9 mL.kg-1.h-1 (72 patients). Percentage of major complications (Clavien-Dindo grade III–IV) and length hospital stay were the main outcomes variables.
Results
Of the 106 enrolled patients, 68.9% were women; 46.2% had ovarian cancer, 35.84% colorectal cancer, and 7.5% peritoneal cancer. The average fluid administration rate was 11 ± 3.58 mL.kg-1.h-1. The restrictive group suffered a significantly higher percentage of Clavien-Dindo grade III–IV complications (35.29%) compared with the non-restrictive group (15.27%) (p = 0.02). The relative risk associated with restrictive therapy was 1.968 (95% confidence interval: 1.158–3.346). We also found a significant difference for hospital length of stay, 20.91 days in the restrictive group vs 16.19 days in the non-restrictive group (p = 0.038).
Conclusions
Intraoperative fluid therapy restriction below 9 mL.kg-1.h-1 in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy was associated with a higher percentage of major postoperative complications.
Keywords
Resumo
Introdução: A fluidoterapia intraoperatória em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica desempenha um papel importante na morbidade pós-operatória. Estudos encontraram associação entre sobrecarga de fluidoterapia e aumento de complicações pós-operatórias, aconselhando fluidoterapia intraoperatória restritiva. Nosso objetivo neste estudo foi comparar a morbidade associada à fluidoterapia intraoperatória restritiva versus não restritiva. Métodos: Análise retrospectiva de um banco de dados coletado prospectivamente no Serviço de Anestesiologia do Hospital Virgen del Rocío, de dezembro de 2016 a abril de 2019. Cento e seis pacientes submetidos à cirurgia citorredutora completa e quimioterapia intraperitoneal hipertérmica foram divididos em duas coortes de acordo com a fluidoterapia recebida 1. Restritivo ≤ 9 ml.kg-1.h-1 (34 pacientes), 2. Não restritivo ≥ 9 ml.kg-1.h-1 (72 pacientes). Percentual de complicações maiores (Clavien-Dindo grau III-IV) e tempo de internação foram as principais variáveis de desfecho. Resultados: Dos 106 pacientes inscritos, 68,9% eram mulheres; 46,2% tinham câncer de ovário, 35,84% câncer colorretal e 7,5% câncer peritoneal. A taxa média de administração de fluidos foi de 11 ± 3,58 ml´.kg-1.h-1. O grupo restritivo sofreu um percentual significativamente maior de complicações grau III-IV de Clavien-Dindo (35,29%) em comparação com o grupo não restritivo (15,27%) (p = 0,02). O risco relativo associado à terapia restritiva foi de 1,968 (intervalo de confiança de 95%: 1,158–3,346). Também encontramos diferença significativa para o tempo de internação, 20,91 dias no grupo restritivo vs 16,19 dias no grupo não restritivo (p=0,038). Conclusões: A restrição de fluidoterapia intraoperatória abaixo de 9 ml.kg-1.h-1 em cirurgia citorredutora com quimioterapia intraperitoneal hipertérmica foi associada a um maior percentual de complicações pós-operatórias maiores.
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References
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