The influence of fluid therapy on short and long – term outcome in patients undergoing liver resection for malignant indications

Abstract

Although fluid therapy in hepatic surgery affects postoperative course and morbidity, there is paucity of unequivocal guidelines in the literature as to which of three fluid strategies: liberal, restrictive or goal directed should be used. We performed a review of literature regarding fluid management strategies in major abdominal procedures, focusing on hepatic surgery . The quantity and quality of fluids infused perioperatively is often dependant on the preference of the physician , institutional experience and practices. Liberal fluid regimen carries the risk of impaired wound healing and prolonged ileus, furthermore in liver surgery it may increase blood loss. Restrictive fluid therapy is the mainstay of the anesthetic management in hepatic resections, keeping the central venous pressure low controls outflow from the liver and results in decrease in intraoperative blood loss. In recent years, goal directed fluid therapy ( GDFT), as a component of enhancend recovery pathways after surgery (ERAS) programs, has gained popularity. It is based on the concept of hemodynamic optimization in order to ensure optimal tissue perfusion and oxygen delivery. Furthermore, fluid infusion strategy should be individualized in terms of unique pathophysiology of the patient (eg. cirrhosis) and the specific requirements of the surgical technique (laparoscopic procedures). Controversy regarding often contradictory data, leaves the clinician at a loss as to which fluid strategy will best serve the patient. Therefore, it is imperative to design and conduct clinical trials in homogenous group of patients to define the optimal type and amount of fluid for patients undergoing hepatic surgery.