Restrictive transfusion in radical cystectomy is safe

Syan-Bhanvadia, Sumeet; Drangsholt, Siri; Shah, Swar; Cai, Jie; Miranda, Gus; Djaladat, Hooman; Daneshmand, Siamak

doi:10.1016/j.urolonc.2017.04.001

Cited by 13 publications

(17 citation statements)

References 34 publications

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“…The OS rate was reported by 16 studies, which included 18 905 patients. Nine studies reported a significant adverse impact of PBT on OS ( Figure 2 [7,8,[18][19][20][21][22][23][24][25][26][27][28][29][30][31]). Yet, seven studies reported no significant impact of blood transfusion on OS.…”

Section: Overall Survival (Os)mentioning

confidence: 99%

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Prognostic impact of perioperative blood transfusions on oncological outcomes of patients with bladder cancer undergoing radical cystectomy: A systematic review

Volz

Eismann

Pfitzinger

et al. 2020

Arab Journal of Urology

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Section: Overall Survival (Os)mentioning

confidence: 99%

“…Eight studies assessed the impact of PBT on BCa recurrence, including a total number of 8245 patients (Figure 4 [7,8,19,20,23,27,28,31]). There were four studies reporting significantly worse RFS in patients treated with PBT.…”

Section: Recurrence-free Survival (Rfs)mentioning

confidence: 99%

Prognostic impact of perioperative blood transfusions on oncological outcomes of patients with bladder cancer undergoing radical cystectomy: A systematic review

Volz

Eismann

Pfitzinger

et al. 2020

Arab Journal of Urology

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“…Thus, a careful balance between the short-term benefits of blood transfusions in terms of reduction in early major postoperative complications versus the long-term benefits in terms of better cancer-related outcomes should be made depending on the patient's characteristics. Meticulous surgical technique reducing blood loss, restrictive fluid administration avoiding hemodilution, normothermia reducing the risk of coagulopathy, and a restrictive threshold for transfusions of PRBC and FFP are valuable intraoperative options to reduce blood transfusion rates [29,44]. In the era of cryoprecipitate and fibrinogen concentrates, the indication for FFP should be reconsidered as it has been associated with transfusion-associated circulatory overload and transfusionrelated acute lung injury.…”

Section: Discussionmentioning

confidence: 99%

Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study

Engel

Beilstein

Jerney

et al. 2021

JCM

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Open radical cystectomy is associated with a substantial rate of perioperative blood transfusion. Early detection of potentially modifiable perioperative factors could reduce the need for perioperative blood transfusion and thus positively impact the outcome. We conducted an observational, single-center cohort study of 1168 patients undergoing cystectomy. Perioperative blood transfusion was defined as the need for packed red blood cells and/or fresh frozen plasma units within the first 24 h after the initiation of surgery. Multiple logistic regression analysis was performed to model the association between risk factors and blood transfusion, and a nomogram was developed. Blood transfusion occurred in 370/1168 patients (31.7%). Significant predictors were age (OR: 1.678, (95% CI: 1.379–2.042); p < 0.001), blood loss ratio (6.572, (4.878–8.853); p < 0.001), preoperative hemoglobin (0.316, (0.255–0.391); p < 0.001), tumor stage (2.067, (1.317–3.244); p = 0.002), use of oral anticoagulants (2.70, (1.163–6.270), p = 0.021), and interaction between female sex and blood loss ratio (1.344, (1.011–1.787); p = 0.042). Of the major predictors found to affect perioperative blood transfusion, two can be influenced: blood loss ratio by meticulous surgery and hemoglobin by preoperative optimization. Others such as age or advanced disease are not modifiable. This emphasizes the importance of optimal management of patients prior to surgery.

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“… 10 Diamantopoulos et al 95 retrospectively found that PBT did not increase the risk for postoperative complications, but was associated with prolonged hospitalization ⩾ 10 days in the setting of RC (aOR: 2.30, 95% CI: 1.13–4.7, p = 0.022). Syan-Bhanvadia et al 96 conducted a retrospective study investigating the safety of a restrictive transfusion protocol between 173 patients who were transfused restrictively and 87 matched patients transfused liberally. Compared to the liberal cohort, the restrictive group had reduced 90-day (65.6% vs 86.7%, p = 0.007) and high-grade (15.6% vs 34.8%, p = 0.003) complication rates.…”

Section: Targeted Components Of Erasmentioning

confidence: 99%

Updates on enhanced recovery after surgery for radical cystectomy

Lee

Patel

Srivastava

et al. 2022

Therapeutic Advances in Urology

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Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.

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Restrictive transfusion in radical cystectomy is safe

Cited by 13 publications

References 34 publications

Prognostic impact of perioperative blood transfusions on oncological outcomes of patients with bladder cancer undergoing radical cystectomy: A systematic review

Prognostic impact of perioperative blood transfusions on oncological outcomes of patients with bladder cancer undergoing radical cystectomy: A systematic review

Predictors for Perioperative Blood Transfusion in Patients Undergoing Open Cystectomy and Urinary Diversion and Development of a Nomogram: An Observational Cohort Study

Updates on enhanced recovery after surgery for radical cystectomy

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