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Albumin versus colloids in colon surgery patients: preliminary results

Introduction

In colon surgery for malignancy, tissue oedema as a result of increased capillary permeability – due both to operational stress response and the perioperative fluid therapy – may contribute not only to the systemic consequences, but also to anastomotic dehiscence with questionable end results for the patient. The use of albumin is considered the gold standard for prevention of this complication, being at least theoretically combined with hypoalbuminaemia; however, in recent years its use has become controversial. On the other hand, after the acknowledgement of the pharmacokinetic advantages of synthetic colloids, there has been an ongoing shift towards their use as perioperative fluid therapy in major elective surgery, too. We aimed to investigate the effect of colloids as a postoperative regimen against routinely given human albumin in patients subjected to colectomy for cancer. Thirty-day morbidity, including anastomotic leakage, abdominal wound infection and dehiscence, as well as organ-specific and systemic infections, sepsis and septic shock, were assessed.

Methods

Fifty colon cancer patients with actual indication for early postoperative albumin treatment were randomized to receive either human albumin (100 ml/day) or 6% HES 130/0.4 (Voluven; Fresenius AG) (500 ml/day), for six consecutive days. Patients were then followed up for the next 30 days.

Results

In the albumin and Voluven groups, anastomotic leakage was prominent in three patients and one patient, respectively; wound infection in three patients and one patient, respectively; systemic infection in five patients and four patients, respectively; and sepsis in two patients and zero patients, respectively. One patient finally died from sepsis in the albumin group.

Conclusion

We conclude that, in our study, patients receiving Voluven against albumin as a perioperative 6-day treatment exhibited lower morbidity rates. However, further research is required.

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Kotzampassi, K., Grosomanidis, V., Andreopoulos, K. et al. Albumin versus colloids in colon surgery patients: preliminary results. Crit Care 12, P229 (2008). https://doi.org/10.1186/cc6450

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Keywords

  • Anastomotic Leakage
  • Human Albumin
  • Anastomotic Dehiscence
  • Lower Morbidity Rate
  • Synthetic Colloid