Association of Perioperative Fluid Balance and Adverse Surgical Outcomes in Esophageal Cancer and Esophagogastric Junction Cancer

Abstract

Perioperative fluid balance and its association with surgical outcomes in patients with esophageal and esophagogastric junction cancer have not been clearly elucidated. A retrospective study of this association is reported. A retrospective study involving 99 patients undergoing transthoracic esophagectomy or esophagogastrectomy was conducted. The intraoperative and postoperative fluid inputs and outputs as well as postoperative morbidity and mortality were recorded. Univariate analysis and multivariate logistic regression analysis were performed to clarify the effect of fluid balance on postoperative outcomes. There were 78 men and 21 women with an average age of 61.1 +/- 10.9 years in the study. Among them, 68 patients had esophageal cancer and 31 had esophagogastric junction cancer. The postoperative morbidity and mortality were 38.4% and 7.1%, respectively. Compared with favorable outcomes, adverse surgical outcomes were significantly related to larger fluid balance on postoperative day 1 and day 2, and to cumulative fluid balance from the intraoperative period to postoperative day 2 (605.0 +/- 931.5 mL versus 200.1 +/- 712 mL; p = 0.016; 607.8 +/- 743.9 mL versus 200.1 +/- 678.6 mL; p = 0.005; 2,818.5 +/- 1,456.5 mL versus 1,797.1 +/- 1,704.0 mL; p = 0.002, respectively). On multivariate logistic regression analysis, cumulative fluid balance from intraoperative period to postoperative day 2 was independently related to adverse surgical outcomes (odds ratio, 1.000; 95% confidence interval, 1.000 to 1.001; p = 0.014). The cumulative fluid balance from the intraoperative period to postoperative day 2 is a good predictor of surgical outcomes. It can be used as a prognostic tool to evaluate the risk of adverse surgical outcomes.