Abstract
Purpose
The purpose of this prospective single blinded randomized controlled trial was to find out whether goal-directed fluid therapy (GDFT) strategy in post-transection period in low central venous pressure (CVP) assisted laparoscopic hepatectomy (LH) has more benefit than traditional fluid strategy.
Methods
Between April 2020 and Dec 2021, patients who were scheduled for laparoscopic liver resection surgery were eligible to participate in the study. Patients were randomly divided into two groups: control group that received traditional fluid strategy in post-transection period in low CVP assisted laparoscopic hepatectomy and GDFT strategy group that received GDFT strategy in post-transection period. The primary outcome parameter is the incidence of postoperative complications. Secondary outcome parameters include perioperative clinical outcomes, postoperative clinical outcomes, length of hospital stay after surgery, postoperative lactic acid, fluids and vasoactive medications during the operation.
Results
A total of 159 patients in the control group and 160 patients in the GDFT were included. Two groups had no significant difference in the incidence of postoperative complications including pneumonia (P = 0.34), acute kidney injury (P = 0.72), hepatic insufficiency (P = 0.25), pleural effusion (P = 0.08) and seroperitoneum (P = 1.00), respectively. The amount of perioperative urine output is fewer in GDFT group than in the control group (P = 0.0354), while other perioperative variables and postoperative variables were comparable between two groups.
Conclusions
The results show the implementation of GDFT strategy is not associated with fewer postoperative complications. GDFT strategy did not result in improved outcomes in low CVP-assisted laparoscopic hepatectomy.
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Data availability
The data that support the fndings of this study are available on request from the corresponding author, YH.
References
Dutta R, Mahato RI. Recent advances in hepatocellular carcinoma therapy. Pharmacol Ther. 2017;173:106–17.
Yin Z, Fan X, Ye H, Yin D, Wang J. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol. 2013;20(4):1203–15.
Rhu J, Kim SJ, Choi GS, Kim JM, Joh JW, Kwon CHD. Laparoscopic versus open right posterior sectionectomy for hepatocellular carcinoma in a high-volume center: a propensity score matched analysis. World J Surg. 2018;42(9):2930–7.
Pan YX, Wang JC, Lu XY, Chen JB, He W, Chen JC, Wang XH, Fu YZ, Xu L, Zhang YJ, Chen MS, Lai RC, Zhou ZG. Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: a double-blind randomized clinical trial. Surgery. 2020;167(6):933–41.
Mise Y, Sakamoto Y, Ishizawa T, Kaneko J, Aoki T, Hasegawa K, Sugawara Y, Kokudo N. A worldwide survey of the current daily practice in liver surgery. Liver Cancer. 2013;2(1):55–66.
Correa-Gallego C, Berman A, Denis SC, Langdon-Embry L, O’Connor D, Arslan-Carlon V, Kingham TP, D’Angelica MI, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, Melendez J, Fischer M. Renal function after low central venous pressure-assisted liver resection: assessment of 2116 cases. HPB (Oxford). 2015;17(3):258–64.
Vallet B, Blanloeil Y, Cholley B, Orliaguet G, Pierre S, Tavernier B, Socie te franc aise d’anesthe sie et de re a. Guidelines for perioperative haemodynamic optimization. Ann Fr Anesth Reanim. 2013;32(10):e151–8.
Michard F, Giglio MT, Brienza N. Perioperative goal-directed therapy with uncalibrated pulse contour methods: impact on fluid management and postoperative outcome. Br J Anaesth. 2017;119(1):22–30.
Giustiniano E, Procopio F, Ruggieri N, Grimaldi S, Torzilli G, Raimondi F. Impact of the FloTrac/Vigileo™ monitoring on intraoperative fluid management and outcome after liver resection. Dig Surg. 2018;35(5):435–41.
Taylor J. Third universal definition of myocardial infarction. Eur Heart J. 2012;33(20):2506–7.
Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T. Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepatobiliary Pancreat Sci. 2015;22(10):721–7.
Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients. Ann Surg. 2009;250(5):831–41.
Xie SM, Xiong JJ, Liu XT, Chen HY, Iglesia-Garcia D, Altaf K, Bharucha S, Huang W, Nunes QM, Szatmary P, Liu XB. Laparoscopic versus open liver resection for colorectal liver metastases: a comprehensive systematic review and meta-analysis. Sci Rep. 2017;7(1):1012.
Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW, Hausken J, Tonnessen TI, Abildgaard A, Barkhatov L, Yaqub S, Rosok BI, Bjornbeth BA, Andersen MH, Flatmark K, Aas E, Edwin B. Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg. 2018;267(2):199–207.
Mizunoya K, Fujii T, Yamamoto M, Tanaka N, Morimoto Y. Two-stage goal-directed therapy protocol for non-donor open hepatectomy: an interventional before-after study. J Anesth. 2019;33(6):656–64.
Weinberg L, Ianno D, Churilov L, McGuigan S, Mackley L, Banting J, Shen SH, Riedel B, Nikfarjam M, Christophi C. Goal directed fluid therapy for major liver resection: a multicentre randomized controlled trial. Ann Med Surg (Lond). 2019;45:45–53.
Weinberg L, Mackley L, Ho A, McGuigan S, Ianno D, Yii M, Banting J, Muralidharan V, Tan CO, Nikfarjam M, Christophi C. Impact of a goal directed fluid therapy algorithm on postoperative morbidity in patients undergoing open right hepatectomy: a single centre retrospective observational study. BMC Anesthesiol. 2019;19(1):135.
Cain PA, Ahl R, Hedstrom E, Ugander M, Allansdotter-Johnsson A, Friberg P, Arheden H. Age and gender specific normal values of left ventricular mass, volume and function for gradient echo magnetic resonance imaging: a cross sectional study. BMC Med Imaging. 2009;9:2.
Correa-Gallego C, Tan KS, Arslan-Carlon V, Gonen M, Denis SC, Langdon-Embry L, Grant F, Kingham TP, DeMatteo RP, Allen PJ, D’Angelica MI, Jarnagin WR, Fischer M. Goal-directed fluid therapy using stroke volume variation for resuscitation after low central venous pressure-assisted liver resection: a randomized clinical trial. J Am Coll Surg. 2015;221(2):591–601.
de Waal EEC, Frank M, Scheeren TWL, Kaufmann T, de Korte-de BD, Cox B, van Kuijk SMJ, Montenij LM, Buhre W. Perioperative goal-directed therapy in high-risk abdominal surgery. A multicenter randomized controlled superiority trial. J Clin Anesth. 2021;75:110506.
Funding
This research was supported by the Shanghai Municipal Key Clinical Specialty (Grant number: shslczdzk03603) and Edward (Shanghai) Medical Supplies Co., Ltd (Grant number: 2017-ji-27) to Jing Cang.
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Conception and design: JC, HY, SL; administrative support: JC; provision of study materials or patients: HY, SL, YY; collection and assembly of data: YY, PW, LJ; data analysis and interpretation: SL, HY; manuscript writing: all authors; final approval of manuscript: all authors.
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Jing Cang received research support from Edward (Shanghai) Medical Supplies Co., Ltd. Shichao Li, Yue Yin, Pei Wang, Long Jiang and Huan Yan declare that they have no competing interests.
Ethical statement
This study has been approved by the Ethics Committee of Zhongshan Hospital Fudan University (Approval No.: B2018-303R). The study has been registered in Chinese Clinical Trial Registry (www.chictr.org.cn) and the registration number is ChiCTR1900027017. Written informed consent was obtained from all participants. The research is conducted in accordance with the Declaration of Helsinki (as revised in 2013).
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Li, S., Yin, Y., Wang, P. et al. Goal-directed fluid therapy during post-resection phase in low central venous pressure assisted laparoscopic hepatectomy: a randomized controlled superiority trial. J Anesth 38, 77–85 (2024). https://doi.org/10.1007/s00540-023-03282-5
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DOI: https://doi.org/10.1007/s00540-023-03282-5