Goal-directed Fluid Therapy on Complications After Pancreaticoduodenectomy

Study Overview
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Brief Summary
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Optimal fluid balance is critical to minimize anastomotic edema in patients undergoing pancreaticoduodenectomy. This study examined the effects of decreased fluid administration on rates of postoperative pancreatic leak and delayed gastric emptying.

Detailed Description
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Retrospective study of 10564 patients undergoing pancreaticoduodenectomy at a single institution from January, 2015 through July, 2016. Stroke volume variation (SVV) was tracked and titrated during the procedure. All patients were seen preoperatively in the department clinic setting, and indications for pancreaticoduodenectomy were for pancreatic adenocarcinoma, neuroendocrine tumors, chronic pancreatitis, non-adeno malignancy, and other benign. benign and malignant disease. Patients were excluded if they had any of the following during surgery: venous resection and reconstructive involving the portal venous system; estimated blood loss exceeding two liters; high dose steroid administration; use of irreversible electroporation for margin enhancement; lack of SVV equipment or inconsistent SVV recordings; use of the robotic surgical system. Primary outcomes measures were recorded for each patient were: pancreatic leak and delayed gastric emptying. Pancreatic leak was defined according to the international study group for pancreatic fistulas: an external fistula with a drain output of any measurable volume after postoperative day three with an amylase level greater than three times the upper limit of the normal serum value. Delayed gastric emptying was defined clinically as persistent postoperative emesis requiring nasogastric tube placement, prokinetic agents, or hospital readmission for endoscopic gastrostomy placement. A comparative analysis of postoperative complications was performed between patients with a median SVV < 12 during the extirpative and reconstructive phases of the procedure compared with patients with an SVV > 12. The investigators chose an SVV value of greater than 12 to represent a dry state because previous studies have shown that this value represents decreased fluid administration.

Official Title
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The Impact of Intraoperative Goal-directed Fluid Therapy on Complications After Pancreaticoduodenectomy

Conditions
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Pancreaticoduodenectomy, Stroke Volume Variation

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: • pancreatic adenocarcinoma, neuroendocrine tumors, chronic pancreatitis, non-adeno malignancy, and other benign lesion Exclusion Criteria: venous resection and reconstructive involving the portal venous system estimated blood loss exceeding two liters high dose steroid administration use of irreversible electroporation for margin enhancement lack of SVV equipment or inconsistent SVV recordings use of the robotic surgical system

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Patients with SVV < 12<br>Patients undergoing pancreaticoduodenectomy with an intraoperative stroke volume variation of less than 12. | |
| Patients with SVV > or = 12<br>Patients undergoing pancreaticoduodenectomy with an intraoperative stroke volume variation of greater than or equal to 12. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Postoperative complications (Pancreatic leak and delayed gastric emptying) | Number of patients with postoperative pancreatic leak and postoperative delayed gastric emptying. Stroke volume is calculated using measurements of ventricle volumes from an echocardiogram and subtracting the volume of the blood in the ventricle at the end of a beat (called end-systolic volume) from the volume of blood just prior to the beat (called end-diastolic volume). | 30 days postoperatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Fluid therapy, gastric emptying, pancreatic leak, pancreaticoduodenectomy, stroke volume variation