title: A randomized trial of goal directed vs. standard fluid therapy in cytoreductive surgery with hyperthermic intraperitoneal chemotherapy.
abstract: 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.
authors.affiliation: Department of Anaesthesiology, Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Colantonio
authors.forename: Claudia
authors.initials: C
authors.lastname: Claroni
authors.forename: Luana
authors.initials: L
authors.lastname: Fabrizi
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Marcelli
authors.forename: Maria
authors.initials: M
authors.lastname: Sofra
authors.forename: Diana
authors.initials: D
authors.lastname: Giannarelli
authors.forename: Alfredo
authors.initials: A
authors.lastname: Garofalo
authors.forename: Ester
authors.initials: E
authors.lastname: Forastiere
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002985:Clinical Protocols; D000077324:Crystalloid Solutions; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005440:Fluid Therapy; D006040:Goals; D006801:Humans; D007263:Infusions, Parenteral; D007552:Isotonic Solutions; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions