Goal-directed hemodynamic management in patients undergoing primary debulking gynaecological surgery: A matched-controlled precision medicine study

Highlights

• •GDHM may help limit intraoperative fluids amount without generating hyperlactatemia in patients with advanced ovarian cancer.
• •GDHM may enhance bowel function recovery after primary debulking gynaecological surgery.
• •GDHM may shorten length of postoperative hospital stay in high tumor-load patients without comorbidities.

Abstract

Background

Usefulness of intraoperative goal-directed hemodynamic management (GDHM) for patients without comorbidities is debated. After clinical implementation of a pulse contour analysis-guided GDHM protocol, which foresees early vasopressor use for recruiting unstressed volume, we conducted a matched-controlled analysis to explore its impact on the amount of fluids intraoperatively administered to patients without comorbidities who underwent extended abdominal surgery for ovarian cancer.

Methods

After 1:1 matching accounting for body mass index, oncologic disease severity and intraoperative blood losses, 22 patients treated according to this GDHM protocol were compared to a control group of 22 patients who had been managed according to the clinical decision of attending physicians, taken without advanced monitoring. Results are displayed as median[interquartile range].

Results

All analyzed patients underwent radical hysterectomy, bilateral adnexectomy, bowel resection, peritonectomy and extended pelvic/periaortic lymphadenectomy; median length of surgery was 517[480–605] min in patients receiving GDHM and 507[480–600] min in control group. Intraoperatively, patients undergoing GDHM received less fluids (crystalloids 2950[2700–3300] vs. 5150[4700–6000] mL, p < 0.001; colloids 100[50–200] vs. 750[500–1000] mL, p < 0.001) and showed a trend to more frequent vasopressor administration (32 vs 9%, p = 0.13). Greater intraoperative diuresis (540[480–620] mL vs. 450[400–500] mL, p = 0.007), lower blood lactates at surgery end (1.5[1.1–2] vs. 4.1[3.3–5] mmol/L, p < 0.001), shorter time to bowel function recovery (1 [1, 2] vs. 4 [3–5] days, p < 0.001) and hospital discharge (7 [6–8] vs 12 [9–16] days, p < 0.0001) were detected in patients receiving GDHM.

Conclusions

In high-tumor load gynaecological patients without comorbidities who receive radical and prolonged surgery, intraoperative use of this novel GDHM protocol helped limit fluids administration with safety.

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https://www.gynecologiconcology-online.net/article/S0090-8258(18)31164-8/abstract