RESUMO
BACKGROUND: Esophagectomy is associated with significant morbidity. Optimizing perioperative fluid administration is one potential strategy to mitigate morbidity. We sought to investigate the relationship of intraoperative fluid (IOF) administration to outcomes in patients undergoing transhiatal esophagectomy with particular attention to malnourished patients, who may be more susceptible to the effects of fluid overload. MATERIAL AND METHODS: Patients who underwent transhiatal esophagectomy from 2000-2013 were identified from a retrospective database. IOF rates (mL/kg/hr) were determined and their relationship to outcomes compared. To examine the impact of malnutrition, we stratified patients based on median preoperative serum albumin and compared outcomes. RESULTS AND DISCUSSION: 211 patients comprised the cohort. 74% of patients underwent esophagectomy for esophageal adenocarcinoma. Linear regression analyses were performed comparing independent perioperative variables to four outcomes variables: length of stay, complications per patient, major complications, and Clavien-Dindo classification. IOF rate was significantly associated with three of four outcomes on univariate analysis. Significantly more patients with a preoperative albumin level ≤3.7 g/dL who received more than the median IOF rate experienced more severe complications. CONCLUSIONS: Increased intraoperative fluid administration is associated with perioperative morbidity in patients undergoing transhiatal esophagectomy. Patients with lower preoperative albumin levels may be particularly sensitive to the effects of volume overload.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Hidratação/efeitos adversos , Desnutrição/complicações , Assistência Perioperatória/efeitos adversos , Complicações Pós-Operatórias/etiologia , Adenocarcinoma/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Esofágicas/complicações , Esofagectomia/métodos , Feminino , Hidratação/métodos , Humanos , Tempo de Internação , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Excision of a pulmonary nodule by video-assisted thoracoscopic surgery can be difficult when the lesion is deep to the pleural surface. As lung staples are applied, the lung lesion may retract centrally, making continued localization by palpation impossible. We describe a thoracoscopic lung clamp with a novel open end allowing gentle retraction and continuous localization of the nodule during a video-assisted thoracoscopic surgery biopsy.