BackgroundRecent 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.MethodsProspective analysis of 350 major pancreatic resections performed in 2016 at the Department of General and Pancreatic SurgeryThe 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.ResultsLiberal 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.ConclusionConsidering 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.

Clinical Implications of Intraoperative Fluid Therapy in Pancreatic Surgery

Andrianello, S;Marchegiani, G;Bannone, E;Masini, G;Malleo, G;Polati, E;Bassi, C;Salvia, R
2018-01-01

Abstract

BackgroundRecent 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.MethodsProspective analysis of 350 major pancreatic resections performed in 2016 at the Department of General and Pancreatic SurgeryThe 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.ResultsLiberal 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.ConclusionConsidering 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.
2018
Pancreas surgery
ERAS
Intraoperative fluids
Liberal
Near zero
Outcomes
Adult
Aged
Anastomosis, Surgical
Blood Volume
Female
Fluid Therapy
Humans
Intraoperative Care
Male
Middle Aged
Pancreas
Pancreatectomy
Pancreatic Fistula
Pancreaticoduodenectomy
Postoperative Complications
Prospective Studies
Risk Factors
Water-Electrolyte Imbalance
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1031981
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