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Randomized Controlled Trial Of Liberal Versus Restricted Fluid Management In Patients Undergoing Pancreatectomy
Florence M. Grant*, Murray F Brennan, Peter J. Allen, Ronald DeMatteo, T. Peter Kingham, Michael D'Angelica, Mary E. Fischer*, Mithat Gonen*, William Jarnagin
Memorial Sloan-Kettering Cancer Center, New York, NY

OBJECTIVE(S):
Randomized controlled trials in patients undergoing major intraabdominal surgery have challenged the historical use of liberal (LIB) fluid utilization, suggesting a more restrictive (RES) regimen is associated with fewer post operative complications. Given the significant morbidity associated with pancreatic resection, we completed a randomized trial comparing 2 fluid regimens.
METHODS:
Patients scheduled to undergo pancreatic resection (proximal, +central, (PD) and distal (DP)) were consented for randomization to a LIB (n=164) or RES (n=166) fluid regimen perioperatively. Sample size was designed with 80% power to change grade 3 complications from 35% to 21%. Intraoperatively, LIB patients received
12/ML/KG/HR and RES patients 6ML/KG/HR. Cumulative crystalloid given (median, range, ml) days 0 through 3 was LIB: 12252 (6600-21365), RES 7808 (2700-16274) p<.0001.
RESULTS:
Between July 2009 and July 2015, we randomized 330 patients undergoing PD (n=218) or DP (n=112). Patients were equally distributed for all demographic and intraoperative characteristics. On day 0, 9.3 % of LIB patients undergoing PD were transfused compared to 1.8% RES (p=0.02). Thirty day mortality was 2/330 (0.6%). Median operative time for PD was 225mins (106-462) and DP 150 (44-324). Grade 3 or greater complications occurred in 29% of LIB and 35% of RES (p=0.5). Median length of stay was PD, 7 and DP, 5 days in both arms.
CONCLUSIONS:
In a high volume institution, major perioperative complications from pancreatic resection were not significantly influenced by fluid regimens that differed approximately 1.6 fold.


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