Influence of intraoperative fluid volume on pulmonary complications in patients undergoing minimally invasive endoscopic esophagectomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Ying ^1,2 , SHANG Kaixi ³ , TIAN Wei ⁴ , SUN Qirong ¹ ,  YU Hai ¹

1. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Anesthesiology, Liangshan Prefecture Hospital of Integrated Traditional Chinese and Western Medicine, Xichang, 615000, Sichuan, P. R. China;
3. Department of Anesthesiology, Chengdu Office Hospital of the People's Government of Tibet Autonomous Region, Chengdu, 610041, P. R. China;
4. Department of Anesthesiology, Neijiang People's Hospital, Neijiang, 641400, Sichuan, P. R. China;

Corresponding author：

YU Hai, Email: yuhaishan117@yahoo.com

Keywords：

Intraoperative fluid infusion volume; minimally invasive surgery for esophageal cancer; postoperative pulmonary complications

DOI：

10.7507/1007-4848.202112002

Video：

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Objective To evaluate the effect of intraoperative fluid infusion volume on postoperative pulmonary complications (PPCs) in patients after minimally invasive endoscopic esophageal carcinoma resection. Methods From June 2019 to August 2021, 486 patients undergoing elective minimally invasive endoscopic esophagectomy for esophageal cancer were retrospectively screened from the electronic medical record information management system and anesthesia surgery clinical information system of West China Hospital of Sichuan University. There were 381 males and 105 females, with a median age of 64.0 years. Taking the incidence of pulmonary complications within 7 days after operation as the primary outcome, the correlation between intraoperative fluid infusion volume and the occurrence of PPCs within 7 days was clearly analyzed by regression analysis. Results The incidence of pulmonary complications within 7 days after surgery was 33.5% (163/486). Regression analysis showed that intraoperative fluid infusion volume was correlated with the occurrence of PPCs [adjusted OR=1.089, 95%CI (1.012, 1.172), P=0.023], especially pulmonary infection [adjusted OR=1.093, 95%CI (1.014, 1.178), P=0.020], and pleural effusion [adjusted OR=1.147, 95%CI (1.007, 1.306), P=0.039]. Pulmonary infection was significantly less in the low intraoperative fluid infusion group [<6.49 mL/(kg·h), n=115] compared with the high intraoperative fluid infusion group [≥6.49 mL/(kg·h), n=371] (18.3% vs. 34.5%, P=0.023). Intraoperative fluid infusion volume was positively associated with death within 30 days after surgery [adjusted OR=1.442, 95%CI (1.056, 1.968), P=0.021]. Conclusion Among patients undergoing elective minimally invasive endoscopic esophageal cancer resection, intraoperative fluid infusion volume is related with the occurrence of PPCs within 7 days after the surgery, especially pulmonary infection and pleural effusion, and may affect death within 30 days after the surgery.

Citation： CHEN Ying, SHANG Kaixi, TIAN Wei, SUN Qirong, YU Hai. Influence of intraoperative fluid volume on pulmonary complications in patients undergoing minimally invasive endoscopic esophagectomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 717-723. doi: 10.7507/1007-4848.202112002 Copy

1.	Xing X, Gao Y, Wang H,, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis, 2015, 7(11): 1986-1993.
2.	Haverkamp L, Seesing MF, Ruurda JP, et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus, 2017, 30(1): 1-7.
3.	Durkin C, Schisler T, Lohser J. Current trends in anesthesia for esophagectomy. Curr Opin Anaesthesiol, 2017, 30(1): 30-35.
4.	Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS ®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
5.	Karaman Ilić M, Madžarac G, Kogler J, et al. Intraoperative volume restriction in esophageal cancer surgery: An exploratory randomized clinical trial. Croat Med J, 2015, 56(3): 290-296.
6.	Casado D, López F, Martí R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus, 2010, 23(7): 523-528.
7.	Wei S, Tian J, Song X, et al. Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg, 2008, 86(1): 266-272.
8.	Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth, 2014, 18: 36-44.
9.	Masi A, Desiato V, Melis M, et al. Increased intraoperative fluid volume administration is associated with worse outcomes after gastro-esophageal resection for cancer. J Am Coll Surg, 2015, 2: e129-e130.
10.	Hampton JP, Owodunni OP, Bettick D, et al. Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes. Surgery, 2019, 166(1): 75-81.
11.	Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surgical Endoscopy, 2016, 31(6): 1-11.
12.	Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
13.	Low D, Al De Rson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286.
14.	Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies for the STROBE initiative. Ann Intern Med, 2007, 85(11): 867-872.
15.	石薇, 任益锋, 余海. 围术期静脉输注利多卡因在胸科手术中的应用进展. 中国胸心血管外科临床杂志, 2020, 27(5): 579-583.
16.	Wu H, Wang W, Zhao G, et al. Effect of intraoperative fluid administration on perioperative outcomes in patients undergoing McKeown esophagogastrostomy. Chin J Cancer Res, 2019, 31(5): 742-748.
17.	D'Souza RS, Sims CR 3rd, Andrijasevic N, et al. Pulmonary complications in esophagectomy based on intraoperative fluid rate: A single-center study. J Cardiothorac Vasc Anesth. 2021, 35(10): 2952-2960.
18.	Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth. 2014, 18(1): 36-44.
19.	Carney A, Dickinson M. Anesthesia for esophagectomy. Anesthesiol Clin, 2015, 33(1): 143-163.
20.	Veelo DP, van Berge Henegouwen MI, Ouwehand KS, et al. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One, 2017, 12(3): e0172806.
21.	Taniguchi H, Sasaki T, Fujita H, et al. Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clin Nutr ESPEN, 2018, 23: 184-193.
22.	何蕾蕾, 蒋加丽, 代顺慧, 等. 麻醉药物对成人患者心脏术后肺部并发症的影响. 中国胸心血管外科临床杂志, 2021, 28(3): 339-343.
23.	金亮, 玉红, 毛文杰, 等. 通气模式对胸腔镜肺切除术患者术后肺部并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(2): 211-218.
24.	van Workum F, Stenstra MHBC, Berkelmans GHK, et al. Learning curve and associated morbidity of minimally invasive esophagectomy: A retrospective multicenter study. Ann Surg, 2019, 269(1): 88-94.

1. Xing X, Gao Y, Wang H,, et al. Correlation of fluid balance and postoperative pulmonary complications in patients after esophagectomy for cancer. J Thorac Dis, 2015, 7(11): 1986-1993.
2. Haverkamp L, Seesing MF, Ruurda JP, et al. Worldwide trends in surgical techniques in the treatment of esophageal and gastroesophageal junction cancer. Dis Esophagus, 2017, 30(1): 1-7.
3. Durkin C, Schisler T, Lohser J. Current trends in anesthesia for esophagectomy. Curr Opin Anaesthesiol, 2017, 30(1): 30-35.
4. Low DE, Allum W, De Manzoni G, et al. Guidelines for perioperative care in esophagectomy: Enhanced Recovery After Surgery (ERAS ®) Society recommendations. World J Surg, 2019, 43(2): 299-330.
5. Karaman Ilić M, Madžarac G, Kogler J, et al. Intraoperative volume restriction in esophageal cancer surgery: An exploratory randomized clinical trial. Croat Med J, 2015, 56(3): 290-296.
6. Casado D, López F, Martí R. Perioperative fluid management and major respiratory complications in patients undergoing esophagectomy. Dis Esophagus, 2010, 23(7): 523-528.
7. Wei S, Tian J, Song X, et al. Association of perioperative fluid balance and adverse surgical outcomes in esophageal cancer and esophagogastric junction cancer. Ann Thorac Surg, 2008, 86(1): 266-272.
8. Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth, 2014, 18: 36-44.
9. Masi A, Desiato V, Melis M, et al. Increased intraoperative fluid volume administration is associated with worse outcomes after gastro-esophageal resection for cancer. J Am Coll Surg, 2015, 2: e129-e130.
10. Hampton JP, Owodunni OP, Bettick D, et al. Compliance to an enhanced recovery pathway among patients with a high frailty index after major gastrointestinal surgery results in improved 30-day outcomes. Surgery, 2019, 166(1): 75-81.
11. Chimukangara M, Helm MC, Frelich MJ, et al. A 5-item frailty index based on NSQIP data correlates with outcomes following paraesophageal hernia repair. Surgical Endoscopy, 2016, 31(6): 1-11.
12. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology, 2010, 113(6): 1338-1350.
13. Low D, Al De Rson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with esophagectomy: Esophagectomy Complications Consensus Group (ECCG). Ann Surg, 2015, 262(2): 286.
14. Von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies for the STROBE initiative. Ann Intern Med, 2007, 85(11): 867-872.
15. 石薇, 任益锋, 余海. 围术期静脉输注利多卡因在胸科手术中的应用进展. 中国胸心血管外科临床杂志, 2020, 27(5): 579-583.
16. Wu H, Wang W, Zhao G, et al. Effect of intraoperative fluid administration on perioperative outcomes in patients undergoing McKeown esophagogastrostomy. Chin J Cancer Res, 2019, 31(5): 742-748.
17. D'Souza RS, Sims CR 3rd, Andrijasevic N, et al. Pulmonary complications in esophagectomy based on intraoperative fluid rate: A single-center study. J Cardiothorac Vasc Anesth. 2021, 35(10): 2952-2960.
18. Chau EH, Slinger P. Perioperative fluid management for pulmonary resection surgery and esophagectomy. Semin Cardiothorac Vasc Anesth. 2014, 18(1): 36-44.
19. Carney A, Dickinson M. Anesthesia for esophagectomy. Anesthesiol Clin, 2015, 33(1): 143-163.
20. Veelo DP, van Berge Henegouwen MI, Ouwehand KS, et al. Effect of goal-directed therapy on outcome after esophageal surgery: A quality improvement study. PLoS One, 2017, 12(3): e0172806.
21. Taniguchi H, Sasaki T, Fujita H, et al. Effects of goal-directed fluid therapy on enhanced postoperative recovery: An interventional comparative observational study with a historical control group on oesophagectomy combined with ERAS program. Clin Nutr ESPEN, 2018, 23: 184-193.
22. 何蕾蕾, 蒋加丽, 代顺慧, 等. 麻醉药物对成人患者心脏术后肺部并发症的影响. 中国胸心血管外科临床杂志, 2021, 28(3): 339-343.
23. 金亮, 玉红, 毛文杰, 等. 通气模式对胸腔镜肺切除术患者术后肺部并发症影响的回顾性队列研究. 中国胸心血管外科临床杂志, 2022, 29(2): 211-218.
24. van Workum F, Stenstra MHBC, Berkelmans GHK, et al. Learning curve and associated morbidity of minimally invasive esophagectomy: A retrospective multicenter study. Ann Surg, 2019, 269(1): 88-94.

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