Impact of Intraoperative Fluid Volume on Complications After Minimally Invasive Esophagectomy: Analysis of 8782 Patients From the Japanese National Clinical Database.

Background: Excess intraoperative fluid can increase postoperative complications in elective surgery, but data on esophageal cancer surgery remain limited. We examined the relationship between intraoperative fluid volume and short-term outcomes after minimally invasive esophagectomy. Methods: This study analyzed 8782 patients who underwent minimally invasive esophagectomy between 2018 and 2022 using data from the National Clinical Database in Japan. Multivariable logistic regression and smoothing spline models were used to assess associations between intraoperative fluid volume and short-term outcomes. Results: The median intraoperative fluid volume was 3700 mL (3000-4500) or 7.8 mL/kg/h (6.2-9.7). Postoperatively, pneumonia occurred in 13.6% of patients, anastomotic leakage in 13.1%, prolonged ventilation (> 48 h) in 3.5%, and surgery-related mortality in 0.8%. Patients were classified into tertiles (low, middle, high) based on fluid volume. A high intraoperative fluid volume was significantly associated with pneumonia (risk-adjusted odds ratio 1.22, 95% confidence interval 1.04-1.45, Conclusions: Higher intraoperative fluid volume was significantly associated with an increased risk of pneumonia after minimally invasive esophagectomy.