TY - JOUR
T1 - A Randomized Trial of Goal Directed vs Standard Fluid Therapy in Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy
AU - Colantonio, Luca
AU - Claroni, Claudia
AU - Fabrizi, Luana
AU - Marcelli, Maria Elena
AU - Sofra, Maria
AU - Giannarelli, Diana
AU - Garofalo, Alfredo
AU - Forastiere, Ester
PY - 2015
Y1 - 2015
N2 - The use of adequate fluid therapy during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. The aim of the study was to assess whether the use of fluid therapy protocol combined with goal-directed therapy (GDT) is associated with a significant change in morbidity, length of hospital stay, and mortality compared to standard fluid therapy. Patients American Society of Anesthesiologists (ASA) II–III undergoing CRS and HIPEC were randomized into two groups. The GDT group (N = 38) received fluid therapy according to a protocol guided by monitored hemodynamic parameters. The control group (N = 42) received standard fluid therapy. We evaluated incidence of major complications, total length of hospital stay, total amount of fluids administered, and mortality rate. The incidence of major abdominal complications was 10.5 % in GDT group and 38.1 % in the control group (P = 0.005). The median duration of hospitalization was 19 days in GDT group and 29 days in the control group (P <0.0001). The mortality rate was zero in GDT group vs 9.5 % in the control group (P = 0.12). GDT group received a significantly (P <0.0001) lower amount of fluid (5812 ± 1244 ml) than the control group (8269 ± 1452 ml), with a significantly (P <0.0001) lower volume of crystalloids (3884 ± 1003 vs 68,528 ± 1413 ml). In CRS and HIPEC, the use of a GDT improves outcome in terms of incidence of major abdominal and systemic postoperative complications and length of hospital stay, compared to standard fluid therapy protocol.
AB - The use of adequate fluid therapy during cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. The aim of the study was to assess whether the use of fluid therapy protocol combined with goal-directed therapy (GDT) is associated with a significant change in morbidity, length of hospital stay, and mortality compared to standard fluid therapy. Patients American Society of Anesthesiologists (ASA) II–III undergoing CRS and HIPEC were randomized into two groups. The GDT group (N = 38) received fluid therapy according to a protocol guided by monitored hemodynamic parameters. The control group (N = 42) received standard fluid therapy. We evaluated incidence of major complications, total length of hospital stay, total amount of fluids administered, and mortality rate. The incidence of major abdominal complications was 10.5 % in GDT group and 38.1 % in the control group (P = 0.005). The median duration of hospitalization was 19 days in GDT group and 29 days in the control group (P <0.0001). The mortality rate was zero in GDT group vs 9.5 % in the control group (P = 0.12). GDT group received a significantly (P <0.0001) lower amount of fluid (5812 ± 1244 ml) than the control group (8269 ± 1452 ml), with a significantly (P <0.0001) lower volume of crystalloids (3884 ± 1003 vs 68,528 ± 1413 ml). In CRS and HIPEC, the use of a GDT improves outcome in terms of incidence of major abdominal and systemic postoperative complications and length of hospital stay, compared to standard fluid therapy protocol.
KW - Chemotherapy
KW - Fluid therapy
KW - Postoperative complications
KW - Randomized controlled trial
KW - Regional perfusion
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U2 - 10.1007/s11605-015-2743-1
DO - 10.1007/s11605-015-2743-1
M3 - Article
C2 - 25595308
AN - SCOPUS:84925543806
VL - 19
SP - 722
EP - 729
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
IS - 4
ER -