A case of thoracic esophageal cancer undergone esophagectomy after induction chemotherapy in a Jehovah's Witness

Abstract

We report the case of a 50-year-old female Jehovah's Witness with advanced esophageal cancer who underwent esophagectomy following induction chemotherapy. She visited our hospital complaining of dysphagia and was diagnosed of advanced esophageal cancer by upper endoscopy. She refused allogeneic transfusion. Induction chemotherapy was performed. Severe anemia occurred as an adverse event. A subtotal esophagectomy was performed after her anemia improved. During the surgery, a large volume of replacement fluid was injected, the blood was diluted, and intraoperative bleeding was relatively reduced. Intraoperative blood salvage was made using Cell Saver. The postoperative course were stable by using autologous blood and albumin infusion. The patient was discharged on postoperative day 27. Jehovah's Witnesses with gastrointestinal malignancies can be treated safely by performing surgical therapy based on blood replacement therapy and autologous blood transfusion.

Impact of Peri-Operative Anemia and Blood Transfusions in Patients with Gastric Cancer Receiving Gastrectomy

“…Indeed, accumulating evidence proved that excess blood transfusion during surgery might not improve but even aggravated the prognosis and increased post-operative complications, especially in curative surgery for malignancies (Meng et al, 2013;Aquina et al, 2015;Diaz-Cambronero et al, 2015;Li et al, 2015;Prescott et al, 2015). Hence, oncologic surgeries without blood transfusion were developed without increased post-operative complications by means of replacement fluid administration, autologous blood infusion, parenteral iron supplement and the use of erythropoietic-stimulating agents (Lee et al, 2014;Borstlap et al, 2015;Diaz-Cambronero et al, 2015;Inoue et al, 2015). Recently, it was reported that such novel methods for blood preservation could be practical in oncologic surgeries, particularly for the selected populations such as patients with uncommon blood types or multiple RBC allo-antibodies, as well as Jehovah's Witnesses.…”

Our experience of lung resection in patients who decline blood transfusion for religious reasons

“…However, detailed treatment plans have been entrusted to each institution, and invasive treatment for JWs remains a medical and ethical issue. Some reports have described surgical treatment for JWs [1,2,[7][8][9]. Although case reports have described abdominal surgery, cardiovascular surgery, and liver or lung transplantation, very few have mentioned pulmonary surgery, especially cases of lung cancer [10,11].…”

“…Some reports have described surgical treatment for JWs [ 1 , 2 , 7 – 9 ]. Although case reports have described abdominal surgery, cardiovascular surgery, and liver or lung transplantation, very few have mentioned pulmonary surgery, especially cases of lung cancer [ 10 , 11 ].…”

“…Some reports have described perioperative prevention of bleeding and anemia for JW patients, but indicators of strategies for malignant tumor surgery in JW patients have remained lacking. Some recent reports have described experiences with JW, such as case reports of esophageal cancer surgery [ 1 ] and sigmoid colon cancer [ 2 ]. However, very few reports have examined issues with pulmonary surgery.…”