Malignant ascites (MA) is most commonly observed in patients scheduled for
epithelial ovarian cancer (EOC) surgery and is supposed as a major risk factor
promoting perioperative hemodynamic deterioration. We aimed to assess the
hemodynamic consequences of MA on systemic circulation in patients undergoing
cytoreductive EOC surgery. This study is a predefined post-hoc analysis of a
randomized controlled pilot trial comparing intravenous solutions within a
goal-directed algorithm to optimize hemodynamic therapy in patients undergoing
cytoreductive EOC surgery. Ascites was used to stratify the EOC patients prior
to randomization in the main study. We analyzed 2 groups according to the
amount of ascites (NLAS: none or low ascites [<500 mL] vs HAS: high ascites
group [>500 mL]). Differences in hemodynamic variables with respect to time
were analyzed using nonparametric analysis for longitudinal data and
multivariate generalized estimating equation adjusting the analysis for the
randomized study groups of the main study. A total of 31 patients in the NLAS
and 16 patients in the HAS group were analyzed. Although cardiac output was
not different between groups suggesting a similar circulatory blood flow, the
HAS group revealed higher heart rates and lower stroke volumes during surgery.
There were no differences in pressure-based hemodynamic variables. In the HAS
group, fluid demands, reflected by the time to reindication of a fluid
challenge after preload optimization, increased steadily, whereas stroke
volume could not be maintained at baseline resulting in hemodynamic
instability after 1.5 h of surgery. In contrast, in the NLAS group fluid
demands were stable and stroke volume could be maintained during surgery.
Clinically relevant associations of the type of fluid replacement with
hemodynamic consequences were particularly observed in the HAS group, in which
transfusion of fresh frozen plasma (FFP) was associated to an improved
circulatory flow and reduced vasopressor and fluid demands, whereas the
administration of artificial infusion solutions was related to opposite
effects. Malignant ascites >500 mL implies increased fluid demands and
substantial alterations in circulatory blood flow during cancer surgery. Fresh
frozen plasma transfusion promotes recovering hemodynamic stability in
patients with malignant ascites >500 mL, in whom artificial infusion solutions
could not prevent from hemodynamic deterioration
