title: Prospective Randomized Controlled Trial of Liberal Vs Restricted Perioperative Fluid Management in Patients Undergoing Pancreatectomy.
abstract: OBJECTIVE
  The aim of this study is to examine, by a prospective randomized controlled trial, the influence of liberal (LIB) vs restricted (RES) perioperative fluid administration on morbidity following pancreatectomy.
  
  
  BACKGROUND
  Randomized controlled trials in patients undergoing major intra-abdominal surgery have challenged the historical use of LIB fluid administration, suggesting that a more restricted regimen may be associated with fewer postoperative complications.
  
  
  METHODS
  Patients scheduled to undergo pancreatic resection were consented for randomization to a LIB (n = 164) or RES (n = 166) perioperative fluid regimen. Sample size was designed with 80% power to decrease Grade 3 complications from 35% to 21%.
  
  
  RESULTS
  Between July 2009 and July 2015, we randomized 330 patients undergoing pancreaticoduodenectomy (PD, n = 218), central (n = 16), or distal pancreatectomy (DP, n = 96). Patients were equally distributed for all demographic and intraoperative characteristics. Intraoperatively, LIB patients received crystalloid 12 mL/kg/h and RES patients 6 mL/kg/h. Cumulative crystalloid given (median, range, mL) days 0 to 3 was LIB: 12,252 (6600 to 21,365), RES 7808 (2700 to 16,274) P < 0.0001. Sixty-day mortality was 2 of 330 (0.6%). Median operative time for PD was 227 minutes (105 to 462) and DP 150 (44 to 323). Grade 3 complications occurred in 20% of LIB and 27% of RES patients (P = 0.6). Median length of stay was 7 and 5 days for PD and DP, respectively, in both arms.
  
  
  CONCLUSIONS
  In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6-fold.
authors.affiliation: *Departments of Anesthesiology and Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY †Department of Anesthesiology and Critical Care Medicine, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY ‡Department of Surgery, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY §Department of Epidemiology and Biostatistics, Memorial Hospital, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Florence
authors.initials: F
authors.lastname: Grant
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
authors.forename: Michael
authors.initials: M
authors.lastname: D'Angelica
authors.forename: Mary E
authors.initials: ME
authors.lastname: Fischer
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Hao
authors.initials: H
authors.lastname: Zhang
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077324:Crystalloid Solutions; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007552:Isotonic Solutions / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D019990:Perioperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000077324:Crystalloid Solutions; D007552:Isotonic Solutions