Strategies for infusion therapy in pancreaticoduodenectomy (literature review)

Introduction. Fluid therapy is an integral component of anesthetic and resuscitation management in the early perioperative period following abdominal oncological surgery. Optimizing fluid therapy remains particularly challenging in hepatopancreatobiliary surgery, particularly during pancreaticoduodenectomy (PD). Currently, there is no consensus in the scientific community regarding the optimal regimen and strategy for fluid therapy during PD.

The objective was to analyze the clinical efficacy of different infusion therapy strategies in PD.

Materials and methods. A review of studies, systematic reviews, meta-analyses, and clinical guidelines on fluid therapy during pancreaticoduodenectomy was conducted. The search was conducted using PubMed, the Cochrane Controlled Clinical Trials Register, Google Scholar, and e-Library (for Russian authors). Studies from the past ten years were primarily reviewed. Inclusion criteria for the review were text publications comparing restrictive, targeted, and liberal perioperative fluid therapy in patients undergoing PD. Exclusion criteria were duplicates, abstracts, abstracts without a full-text version, and publications not related to the study objective.

Results. Perioperative fluid therapy is a critical factor significantly affecting PD outcomes. Both excessive (liberal) and overly restrictive fluid regimens are associated with an increased risk of postoperative complications, including those specific to PD. An optimal fluid therapy strategy for PD should be balanced, avoiding both hyperand hypovolemia, and take into account individual patient risk factors (pancreatic duct diameter, pancreatic consistency, albumin level).

Conclusion. A modern approach to the strategy of infusion therapy in PD should be personalized, physiologically justified and dynamically controlled and based on a constant assessment of the balance between ensuring adequate organ perfusion and preventing iatrogenic hyperhydration.

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