Authors: Hovgaard HL et al.
Journal: Anesthesiology, Accepted December 26, 2025. DOI: 10.1097/ALN.0000000000005919
Summary
This prospective, single-blind randomized controlled trial evaluated whether extending goal-directed fluid therapy (GDFT) into the postoperative period using individualized blood pressure targets improves outcomes after oesophagectomy. Given the high morbidity associated with oesophagectomy and the limitations of traditional GDFT—particularly fixed mean arterial pressure thresholds and early discontinuation—the investigators tested a more personalized and prolonged hemodynamic strategy.
One hundred patients undergoing oesophagectomy were randomized to either extended GDFT or standard care. In the intervention group, cardiac output was optimized and mean arterial pressure targets were individualized based on each patient’s nighttime baseline blood pressure. The protocol was applied continuously from tracheal intubation through the early postoperative period until 07:00 the following morning. The primary endpoint was overall postoperative morbidity at 30 days, assessed using the Comprehensive Complication Index.
Extended individualized GDFT achieved clear physiologic separation between groups. Patients in the intervention arm had higher cumulative fluid balance, increased norepinephrine requirements, and slightly higher mean arterial pressures. Despite these protocol-driven differences, there was no reduction in postoperative morbidity. The Comprehensive Complication Index at 30 days was nearly identical between the intervention and standard care groups.
These findings suggest that extending and individualizing perioperative hemodynamic targets—while feasible and effective at altering intra- and postoperative management—does not translate into improved clinical outcomes after oesophagectomy. The results highlight the complexity of perioperative physiology in high-risk surgery and suggest that more intensive hemodynamic control alone may be insufficient to reduce postoperative complications in this population.
Key Points
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Extended goal-directed fluid therapy with individualized blood pressure targets was feasible and protocol-adherent.
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The intervention resulted in higher fluid balances, greater vasopressor use, and modestly higher mean arterial pressures.
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No difference was observed in overall postoperative morbidity at 30 days.
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Individualized and prolonged hemodynamic management did not improve outcomes after oesophagectomy.
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Results question whether extending GDFT beyond the operating room provides clinical benefit in high-risk gastrointestinal surgery.
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