Background. An effective treatment for renal cell carcinoma complicated by tumor thrombus (TT) is nephrectomy with thrombectomy (NETE) from the inferior vena cava (IVC), which is associated with massive blood loss, high morbidity and mortality. The study aims to evaluate the infusion-transfusion protocol (ITP) for NETE from the IVC without extracorporeal circulation.
Materials and methods. The observational single-center study included 682 patients who were operated for NETE for renal cell carcinoma with TT. Patients were divided into 3 groups depending on the level of TT according to the Mayo classification. The InfraHepatic (InH) group included patients with TT levels I and II, the RetroHepatic (RH) group included patients with TT level III, and the SupraDiaphragmatic (SD) group included patients with TT level IV. Own concept of moderately advanced infusion in the amount of 130140% of all losses were introduced. Qualitative and quantitative composition of ITP, frequency of use of sympathomimetics, complications and mortality were assessed.
Results. The rate of massive blood loss was 46.9% in the InH group, 74.7% in the RH group, and 86.3% in the SD group. ITP was characterized a significant increase in the absolute values of all infusion media, a decrease the proportion of crystalloids and colloids, an increase the proportion fresh frozen plasma, donated erythrocytes, and proportion of auto-erythrocytes between groups. The frequency of using intraoperative cell salvage in the InH group was 39.6%, in the RH 67.7%, in the SD 90.7%. The greatest hemodynamic shifts were recorded in the SD group. The frequency of postoperative complications was 24.3%, and hospital mortality was 7% with accordance to the ITP, adequate hemodynamic and laboratory monitoring in NETE. Low mortality due to hemorrhagic shock in our study (0.15%) emphasizes the effectiveness of the presented ITP.
Conclusion. The obtained data demonstrate the results of NETE as comparable with those presented in the available literature.
Background. The only effective treatment for renal cell carcinoma with tumor inferior vena cava (IVC) thrombosis is surgery. Nephrectomy with thrombectomy (NETE) is usually associated with clinically significant blood loss. The role of blood-sparing methods using autoerythrocyte reinfusion device (ARD) or replacement of blood loss with donor erythrocytes (DE) on the outcomes of NETE has not been well studied.
Aim. To study the rate of hemostasis disorders with intraoperative ARD use, as well as the effect of ARD and DE transfusions on specific (SS), relapse-free (RFS), and progression-free (PFS) survival of patients with renal cell carcinoma (RCC) after NETE.
Materials and methods. The observational study included medical data of 507 patients with RCC and tumor IVC thrombosis operated after NETE. The median volume of blood loss was 4000 [20006500] mL. In 312 (61.5%) patients, ARD without a leukocyte filter was used to compensate for blood loss (median volume of reinfused autoerythrocytes AE was 1140 [700; 1900] mL). Transfusion of DE was required in 387 (76.3%) cases; the median number of DE transfused doses was 3 [1; 5]; 475 (93.7%) patients were discharged from the hospital. The median follow-up of all surviving patients was 24 (1189) months.
Results. Indications for blood transfusions (DE and AE) were directly correlated to the pN (r=0.101; p=0.024) and pT (r=0.091; p=0.040) categories, respectively. The use of AE had no significant effect on the rate of hemostasis disorders and coagulopathic complications compared to other methods of blood loss replacement: 6.8% (21/311) vs 4.7% (9/193), p=0.227; 5.1% (16/311) vs 4.1% (8/193), p=0.394, respectively. ARD had no effect on SS, RFS (after radical surgery), and PFS (after cytoreductive surgery) after NETE. There was a reduction of SS in patients who received DE transfusions compared with those who did not (hazard ratio 0.4; 95% confidence interval 0.10.9; p=0.048). The effects of DE transfusions on RFS and PFS were not identified.
Conclusion. Intraoperative ARD use is an effective and safe method of correcting anemia, which does not increase the risk of coagulopathic complications or decrease survival rates. The non-use of the leukocyte filter during AE preparation does not worsen the medium-term oncological results of RCC surgical treatment with tumor IVC thrombosis. The effect of DE transfusion on the survival of RCC patients after NETE requires further research.
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