Background and Goal of Study:
Extensive tumor debulking challenges both surgeon and anaesthesiologist but promotes survival in latestage ovarian cancer patients. Little is known about the intraoperative fluid balance and its impact on morbidity and mortality.

Materials and Methods:
In a retrospective analysis, late stage ovarian cancer patients undergoing cytoreductive surgery at our hospital between 2012 and 2015 were analysed. Patients received crystalloid fluids according to clinical needs (e.g. to maintain a mean arterial blood pressure of 60 mmHg) and red blood cells as well as fresh frozen plasma to substitute blood loss. Few patients were extubated in the theatre and transferred to an intermediate care ward, whereas the majority of patients were extubated on intensive care unit. Fluid intake, fluid balance, tumor histology were taken from the patient´s record. Statistical significance was assumed at a p < 0.05.

Results and Discussion:
76 patients at an age of 62 ± 13 (mean ± sd) years were identified. Cytoreductive surgery and anaesthesia lasted for 6:39 ± 1:40 and 8:44 ± 1:48 hours, respectively. It was associated with both a huge fluid intake (11.1 ± 4.1 l) and fluid balance (8.9 ± 3.5 l). Following surgery, 25 patients developed pleural effusion and 7 patients showed an anastomotic leak. Fluid balance correlated significantly (p < 0.05) with the duration of anaesthesia (Pearson r = 0.66), surgery (r = 0.51), ventilation (r = 0.52) and hospital stay (r = 0.33), tumor extent (T-grading, r = 0.33) and FIGO-grading (r = 0.31). Patients that developed anastomotic leak exhibited a significantly (p = 0.003) higher fluid balance (12.7 ± 2.7 l versus 8.7 ± 3.4 l) than those who did not. Comparing patients subdivided into two groups with more and less than 8.9 litres (= population mean) of fluid balance, we observed no difference in survival.

Conclusion(s):
In late stage ovarian cancer patients, surgery aiming at complete cytoreduction is accompanied with long surgery time and fluid intake. The high positive fluid balance is associated with prolonged ventilation, pleural effusion and anastomotic leak but seems to have no impact on survival.

05 / Intraoperative fluid balance during cytoreductive surgery for late-stage ovarian cancer