Introduction/Background Fluid overload and hypovolemia promote postoperative complications in patients undergoing cytoreductive surgery for ovarian cancer. In the present study, postoperative complications and anastomotic leakage (AL) were investigated before and after implementation of pulse pressure variation guided fluid management (PPVGFM) during ovarian cancer surgery.

Methodology n=243 ovarian cancer patients undergoing cytoreductive surgery at the University Hospital Bonn between 01/2015 and 12/2022 were retrospectively identified from the institutional database. Cohort A (CA; n=185 patients) was treated before and cohort B (CB; n=58 patients) after implementation of PPVGFM. Both cohorts were compared with focusing on postoperative complication rates.

Results Ultra severe complications (G4/G5) were exclusively present in CA (p=0.0025). No difference between both cohorts was observed regarding severe complications (G3-G5) (p=0.062). Median positive fluid excess (PFE) was lower in CB (p=0.001). This was independent of tumorload as evaluated by peritoneal cancer index (PCI) (p=0.001) and FIGO stage (p=0.001). Time to first postoperative defecation was shorter in CB (CB: d2 median vs. CA: d3 median; p=0.001). CB had a shorter length of hospital stay (p=0.003), less requirement of intensive medical care (p=0.001) and postoperative ventilation (p=0.001). CB received higher median doses of noradrenalin (p=0.001). In the whole study cohort, there were more severe complications (G3-G5) in case of a PFE >/= 3000ml (p=0.034)), and significantly more anastomotic leakage in case of a PFE>/= 4000ml (p=0.006).

Conclusion Intraoperative fluid reduction in ovarian cancer surgery according to a PPVGFM is safe and significantly reduces ultra severe postoperative complications. PFEs of >/=3000ml and >/= 4000ml were cut offs for significantly more severe complications and anastomotic leakage.

Disclosures The Authors declare that no conflicts of interest exist regarding the present study.