Restrictive versus Liberal Fluid Therapy in Patients Undergoing Pancreaticoduodenectomy

Abstract

Introduction: Pancreaticoduodenectomy(PD) has significant morbidity (50%) and mortality (<5%) which may be influenced by perioperative fluid therapy. Traditional practice was the use of liberal fluid therapy. However, it is unclear what the ideal fluid therapy is for patients undergoing PD. This study was conducted to compare the postoperative complications between Restrictive fluid therapy (RES) and Liberal Fluid Therapy (LIB). Methods: Patients scheduled to undergo PD were consented for randomization to a perioperative Restrictive versus Liberal Fluid Therapy fluid regimen. Sample size was designed with 80% power to decrease Clavien Dindo Grade≥ IIIb complications from 60% to 30%. Sample size calculated was 40. Intraoperatively, RES patients received crystalloid 5ml/kg/hr and LIB patients received 10ml/kg/hr. Results: Between May 2020 and July 2021, 40 patients were included in the study. Patients were equally distributed for all demographic and intraoperative characteristics. Cumulative crystalloid given (median, IQR, ml) upto 24 hr of surgery was 3550 (1437.5) in RES group, 5325 (2525) in LIB group (p<0.001). Median operative time (median, IQR) for PD was 465(198) minutes for restrictive and 420(86) minutes for liberal fluid therapy (p=0.478). Grade ≥ IIIb complications occurred in 8 (40%) of RES and 3(15%) of LIB patients (p=0.08). Median length of hospital stay was 15.5 days and 16 days which was similar, in both study groups. The rate of complications like POPF, PPH and DGE were similar in both groups. Conclusion: The choice between restrictive or liberal fluid therapy did not affect overall major postoperative complications (Clavien Dindo Grade≥ IIIb) in pancreaticoduodenectomy.