Elsevier

Gynecologic Oncology

Volume 144, Issue 1, January 2017, Pages 61-64
Gynecologic Oncology

Perioperative fluid status and surgical outcomes in patients undergoing cytoreductive surgery for advanced epithelial ovarian cancer

https://doi.org/10.1016/j.ygyno.2016.10.027Get rights and content

Highlights

  • Positive fluid status is common after cytoreductive surgery for advanced epithelial ovarian cancer.

  • Positive fluid status after cytoreductive surgery is associated with surgical site infections.

  • Fluid management is a key component of interventions to prevent surgical site infections.

Abstract

Objective

The objective of this study is to investigate the impact of fluid status on perioperative outcomes of patients undergoing cytoreductive surgery (CRS) for advanced epithelial ovarian cancer (EOC).

Methods

Patients undergoing CRS for stage III or IV EOC at a comprehensive cancer center from 12/2010 to 05/2015 were identified. Those who underwent upper abdominal procedures or colon resections were included. Demographic, perioperative, and 30-day complication data were collected. Perioperative weight change was utilized as a surrogate for fluid status. The time to diuresis (tD) was defined as the postoperative day the patient's weight began to downtrend.

Results

One hundred ten patients were included. Median age was 62 years and median BMI 25.8 kg/m2. The majority (74.5%) were stage IIIC. At least 1 bowel resection was performed in 60 cases (54.5%). A median of 5381 mL of crystalloid (range 1000–17,550 mL) and 500 mL of colloids (range 0–2783 mL) was given intraoperatively. The median perioperative weight change was + 7.3 kg (range  0.9 kg to + 35.7 kg). The median tD was 3 days (range 1–17 days). On univariate analysis, net positive fluid status was associated with unscheduled reoperation, anastomotic leak, surgical site infections (SSI), and length of stay > 5 days. On multivariate analysis, fluid status was independently associated with SSI (p = 0.01).

Conclusions

Perioperative fluid excess is common in patients undergoing CRS for EOC and is independently associated with SSI.

Section snippets

Background

The goal of cytoreductive surgery (CRS) in advanced ovarian cancer is complete surgical resection to no gross residual disease. Each incremental decrease in the volume of residual disease after CRS has been associated with progressively improved overall survival [1], [2]. To achieve this goal, multi-organ resections including extensive pelvic dissection, intestinal resection, and upper abdominal procedures are commonly required [3]. While radical CRS may be associated with morbidity and

Methods

After obtaining Institutional Review Board approval, all women who underwent surgery for ovarian, fallopian tube, or peritoneal cancer between 12/2010 and 05/2015 at the Johns Hopkins Hospital were identified using an institutional ovarian cancer registry database. All patients were operated on by experienced gynecologic oncologic surgeons trained in radical upper abdominal and pelvic cytoreductive surgical techniques. Standard antibiotic prophylaxis was administered within 30 min of skin

Results

In total, 110 women underwent surgery for stage III or IV ovarian, fallopian tube, or peritoneal cancer met inclusion criteria. Demographic information is detailed in Table 1. The median patient age was 62 years (range 31–88 years). The median BMI was 25.8 kg/m2 (range 16.6–47.9 kg/m2). The most common comorbidity observed was hypertension (43.6%). Performance status was not available for most patients and, therefore, not included. Stage distributions were as follows: 11 (10.0%) stage IIIA–B; 82

Discussion

Fluid overload refers to a constellation of clinical findings including edema, laboratory changes, pulmonary edema, need for diuretics and heart failure. Daily weight measurement in the post-operative setting has been utilized as an indicator of fluid status [8], [9], [10], [13], [14]. As volume of fluid administration is only one factor in the development of fluid overload, for the current study, perioperative weight increase was used as a comprehensive measure of fluid status. Our study

Conflicts of interest

The authors declare no conflicts of interest.

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