Document Type

Article

Publication Date

1-13-2026

Comments

This article is the author’s final published version in Journal of Gastrointestinal Surgery, Volume 30, Issue 3, 2026, Article number 102316.

The published version is available at https://doi.org/10.1016/j.gassur.2025.102316. Copyright © 2025 The Author(s).

 

Abstract

BACKGROUND: Pancreaticoduodenectomy (PD) is the only curative option for localized pancreatic head and periampullary malignancies. However, PD is associated with significant perioperative morbidity. Perioperative fluid management has emerged as an important modifiable factor influencing surgical outcomes in PD.

METHODS: In this qualitative review, PubMed/Medline searches were performed between March and August 2025 to review the terms "pancreaticoduodenectomy," "fluid management," "Enhanced Recovery After Surgery," "complications," and related terms.

RESULTS: Historically, liberal fluid administration was favored to compensate for third-space losses, but contemporary evidence has linked excessive fluid volumes to complications, such as postoperative pancreatic fistula, anastomotic edema, and increased inflammatory responses. Recent studies, including those utilizing Enhanced Recovery After Surgery (ERAS) protocols, indicate the possible benefit of more restrictive fluid regimens, finding that restrictive fluids are associated with reduced overall complications, lower cardiopulmonary morbidity, and shorter post-operative hospital stays, amongst others. However, overly restrictive strategies may risk hypoperfusion, driving the necessity for a delicate balance between restrictive fluid administration and physiologic demand.

CONCLUSIONS: Goal-directed fluid therapy protocols offer a promising approach to PD fluid management by individualizing fluid delivery, minimizing complications, and improving perfusion metrics, resulting in a more effective restrictive fluid approach. Despite these advancements, heterogeneity in study designs, fluid management definitions, and monitoring tools limits a clear consensus. Future research should prioritize multicenter randomized controlled trials, standardized protocols, and long-term outcome assessments to refine evidence-based, patient-centered fluid management strategies in PD.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

41461352

Language

English

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