Blood loss in surgical oncology: Neglected quality indicator?

Dixon, Elijah; Datta, Indraneel; Sutherland, Francis; Vauthey, Jean Nicolas

doi:10.1002/jso.21187

Cited by 52 publications

(46 citation statements)

References 43 publications

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“…Exposure to blood transfusions is associated with an increased morbidity and mortality in surgical oncology [37,38]. It is therefore critical to control surgical bleeding and to diagnose and correct coagulopathy early.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

Kajdi

Beck‐Schimmer

Held³

et al. 2014

World J Surg Onc

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BackgroundCytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a treatment option for selected patients with peritoneal carcinomatosis. There are limited data available on anaesthesia management and its impact on patients’ outcome. Our aim was to retrospectively analyze and evaluate perioperative management and the clinical course of patients undergoing CRS/HIPEC within a three-year period.MethodsAfter ethic committee approval, patient charts were retrospectively reviewed for patient characteristics, interventions, perioperative management, postoperative course, and complications. Analysis was intervention based. Data are presented as median (range).ResultsBetween 2009 and 2011, 54 consecutive patients underwent 57 interventions; median anaesthesia time was 715 (range 370 to 1135) minutes. HIPEC induced hyperthermia with an overall median peak temperature of 38.1 (35.7-40.2)°C with active cooling. Bleeding, expressed as median blood loss was 0.8 (0 to 6) litre and large fluid shifts occurred, requiring a total fluid input of 8.4 (4.2 to 29.4) litres per patient. Postoperative renal function was dependent on preoperative function and the type of fluids used. Administration of hydroxyethyl starch colloid solution had a significant negative impact on renal function, especially in younger patients. Major complications occurred after 12 procedures leading to death in 2 patients. Procedure time and need for blood transfusion were associated with a significantly higher risk for major complications.ConclusionsCytoreductive surgery with HIPEC is a high-risk surgical procedure associated with major hemodynamic and metabolic changes. As well as primary disease and complexity of surgery, we have shown that anaesthesia management, the type and amount of fluids used, and blood transfusions may also have a significant effect on patients’ outcome.

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Section: Discussionmentioning

confidence: 99%

Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

Kajdi

Beck‐Schimmer

Held³

et al. 2014

World J Surg Onc

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“…This relatively low transfusion rate may be associated with a high proportion (60.5 %) of surgeries performed laparoscopically. Surgical blood loss is one of the most significant perioperative predictors of patient outcome, but represents a rather neglected quality indicator [21]. Adequate surgical technique can reduce the need for transfusions.…”

Section: Discussionmentioning

confidence: 99%

Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

et al. 2012

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The aim of our study was to evaluate the prognostic significance of blood transfusion on recurrence and survival in patients undergoing curative resections for colorectal cancer. Retrospective analysis of prospectively collected data of patients after elective resections for colorectal cancer between January 2001 and December 2009 was undertaken. The main endpoint was overall survival, disease-free survival, and recurrence rate. These data were evaluated in relation to blood transfusion (group A, no blood transfusion; group B, one to two blood transfusions; group C, three and more blood transfusions). A total of 583 patients met the criteria for inclusion in the study. Of these, 132 (22.6 %) patients received blood transfusion in the perioperative period. There were 83 (14.2 %) patients who received one or two blood transfusions and 49 (8.4 %) patients who required three or more transfusions. Patients with three or more transfusions had a significantly worse 5-year overall survival, disease-free survival, and increased incidence of distant recurrences in comparison with the group without transfusion or the group with one or two transfusions. Multivariate analysis showed that the application of three or more blood transfusions is an independent risk factor for overall survival (P 00.001; HR 2.158; 95 % CI 1.370-3.398), disease-free survival (P<0.001; HR 2.514; 95 % CI 1.648-3.836), and the incidence of distant recurrence (P<0.001; HR 2.902; 95 % CI 1.616-5.212). Application of three or more blood transfusions in patients operated for colorectal carcinoma is an adverse prognostic factor. Indications for blood transfusion should be carefully considered not only with regard to the risk of early complications, but also because of the possibility of compromising long-term results.

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“…Kan ve kan ürünleri transfüzyonuna ise hemoglobin düzeyi, hematokrit miktarı ve koagülasyon parametreleri takip edilerek karar verilmelidir. Onkolojik cerrahide kan transfüzyonu artmış morbidite ve mortalite ile birliktedir (31,37). Kajdi ve arkadaşlarının çalışmaları ise artmış transfüzyon ihtiyacı ile majör komplikasyon riskinin arttığını destekler niteliktedir (14).…”

Section: Postoperati̇f Yöneti̇munclassified

Sitoreduktif Cerrahi ve HIPEK’te Anestezi ve Perioperatif Bakim

2017

GMJ

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Blood loss in surgical oncology: Neglected quality indicator?

Cited by 52 publications

References 43 publications

Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

Anaesthesia in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy: retrospective analysis of a single centre three-year experience

Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

Sitoreduktif Cerrahi ve HIPEK’te Anestezi ve Perioperatif Bakim

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