Abstract
Study Objective: This study aimed to investigate whether stroke volume variation (SVV)-guided goal-directed therapy (GDT) can improve postoperative outcomes in elderly patients undergoing minimally invasive esophagectomy (MIE) compared with conventional care.Design: A prospective, randomized, controlled study.Setting: A single tertiary care center with a study period from November 2017 to December 2018.Patients: Patients over 65 years old who were scheduled for elective MIE.Interventions: The GDT protocol included a baseline fluid supplement of 7 ml/kg/h Ringer's lactate solution and SVV optimization using colloid boluses assessed by pulse-contour analysis (PiCCO™). When SVV exceeded 11%, colloid was infused at a rate of 50 ml per minute; if SVV returned below 9% for at least 2 minutes, then colloid was stopped.Measurements: The primary outcome was the incidence of postoperative complications before discharge, as assessed using a predefined list, including postoperative anastomotic leakage, postoperative hoarseness, postoperative pulmonary complications, chylothorax, myocardial injury, and all-cause mortality.Main Results: Sixty-five patients were included in the analysis. The incidence of postoperative complications between groups was similar (GDT 36.4% vs. control 37.5%, P = 0.92). The total fluid volume was not significantly different between the two groups (2,192 ± 469 vs. 2,201 ± 337 ml, P = 0.92). Compared with those in the control group (n = 32), patients in the GDT group (n = 33) received more colloids intraoperatively (874 ± 369 vs. 270 ± 67 ml, P <0.05) and less crystalloid fluid (1,318 ± 386 vs. 1,937 ± 334 ml, P <0.05).Conclusion: The colloid-based SVV optimization during GDT did not significantly reduce the incidence of early postoperative complications after minimally invasive esophagectomy in elderly patients.Clinical Trial Number and Registry URL: ChiCTR-INR-17013352; http://www.chictr.org.cn/showproj.aspx?proj=22883
Highlights
The incidence of postoperative complications and mortality related to esophagectomy is relatively high, especially in elderly patients with cardiovascular or lung disease [1]
The relationship between intraoperative fluid management and postoperative morbidity has been studied for several years in esophageal cancer surgery [6]
A U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay [7]
Summary
The incidence of postoperative complications and mortality related to esophagectomy is relatively high, especially in elderly patients with cardiovascular or lung disease [1]. The morbidity rate and 30-day mortality rate were reported to be up to 64% and 5%, respectively [2, 3]. Despite the use of minimally invasive techniques and well-controlled anesthesia, the incidence of postoperative complications remains high, reaching approximately one thirds [4, 5]. Postoperative complications increase health care costs and extend the length of hospital stay. The relationship between intraoperative fluid management and postoperative morbidity has been studied for several years in esophageal cancer surgery [6]. A U-shaped association was observed between the volume of fluid administered intraoperatively and 30-day mortality, costs, and postoperative length of stay [7]. The optimal volume for esophagectomy has not been determined [8, 9]
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