Abstract PR623

Abstract

Background & Objectives: Massive fluid shifts occur during ovarian cancer (OC) cytoreductive surgery (CRS), which is associated with increased morbidity. Goal directed therapy (GDT) for intra-operative fluid (IOF) has not been widely studied in OC; Only 2 studies showed reduction in median length of stay (LOS) and postoperative morbidity. Objective: To analyse the current IOF management in OC CRS and develop a prospective study comparing GDT versus standard fluid management and measure impact on hospital stay, post-operative morbidity and cost-effectiveness. Materials & Methods: Retrospective observational study using data from electronic medical records between December 2014 and May 2015. Results: Results: Forty-one patients underwent primary debulking surgery (PDS, n=15) or interval debulking (IDS, n=26). Median total IOF administration using standard approach was 5000 ml (crystalloids 3000 ml, colloid 2000 ml). Intra-operative acidosis occurred in 25 % patients, 29 % patients required intraoperative albumin infusion, 56 % required vasopressors on postoperative day 1 (POD1). There was no difference in mean IOF administration between PDS (longer duration of surgery or DOS) (5304 ml, DOS=627 min) vs. IDS (5215 ml, DOS=504 min). Cumulative fluid balance on POD1 was 2435 ml. The median LOS for PDS was 11 days vs. 8 days in IDS. In a later cohort of 4 patients (PDS=3, IDS=1) where GDT was initiated using stroke-volume variability (SVV), median IOF requirement was 8000 ml and no intra- operative acidosis occurred. Conclusion: GDT might give better guidance to replace IOF loss and maintain tissue perfusion in OC CRS.