The impact of perioperative infusion management choice as a component of ERAS on the incidence of perioperative complications in high-risk patients undergoing multiresection surgical interventions for metastatic ovarian cancer

Background. Multiresection and complex surgical interventions such as primary cytoreductive surgeries are typically prolonged procedures requiring laparotomy. They involve extensive surgical volume and are often associated with significant fluid loss, including blood and ascitic losses, insensible dehydration due to evaporation from the abdominal cavity, and perspiration-related fluid depletion. Therefore, surgical interventions for advanced ovarian cancer necessitate a carefully balanced fluid management strategy. Aim: to compare the impact of three intraoperative infusion regimens — liberal, restrictive, and goal-directed — on the incidence of perioperative complications in high-risk patients undergoing primary multiresection surgery for advanced ovarian cancer. Materials and methods. This prospective observational study included 150 women with ASA III somatic status who were randomly divided into three equal groups based on the selected perioperative infusion therapy regimen. The primary safety endpoint was lactate level during surgery and at 6, 12, and 24 hours postoperatively. The secondary endpoints included the incidence of postoperative complications such as anastomotic leakage, acute kidney injury, cardiogenic pulmonary edema, and mortality. Results. Statistically significant differences between the groups were observed in the following parameters: total intraoperative infusion volume (p = 0.001), intraoperative use of vasoactive drugs (p = 0.005), lactate levels at various postoperative time points (p = 0.005), and the incidence of postoperative complications. In the goal-directed infusion therapy group, lactate levels remained consistently lowest throughout all measurements: intraoperatively — 1.1 (0.75–1.8) mmоl/L, at 6 hours — 1.1 (0.9–1.5) mmоl/L, and at 12 hours — 1.0 (0.57–1.2) mmоl/L. In the restrictive and liberal infusion groups, lactate levels were significantly higher, reaching 2.8 (2.2–4) mmоl/L intraoperatively in the restrictive group and 2.7 (2.0–3.0) mmоl/L at 6 hours postoperatively in the liberal infusion group. Conclusions. The goal-directed approach to perioperative infusion management as a component of ERAS demonstrated the best outcomes by ensuring an optimal balance between adequate infusion support and the minimization of complications in high-risk patients undergoing multiresection surgery for advanced ovarian cancer.