Risk Factors for Blood Loss During Sacral Tumor Resection

Abstract

Extensive hemorrhage is a serious complication during sacral tumor resection. Identifying the risk factors predicting the possibility of extensive hemorrhage would be important to predict which patients would need large amounts of transfused blood intraoperatively and postoperatively and which patients would need blood control by vascular occlusion. We retrospectively reviewed 173 patients who underwent sacral tumor resection performed at our institute between 2003 and 2007. Patients with an estimated total blood loss greater than 3000 mL were classified as having a large amount of blood loss. Sixtynine (39.88%) patients had blood loss greater than 3000 mL. Male gender, excessive tumor blood supply, tumors involving the S2 body and cephalad to the S2 body, tumor volume greater than 200 cm 3 , aorta occlusion, surgical approach, reconstruction, and operative time were associated with a large amount of blood loss. Tumors cephalad to the S2-S3 disc space (odds ratio, 3.840), tumor volume greater than 200 cm 3 (odds ratio, 3.381), and excessive blood supply (odds ratio, 2.281) independently predicted a large amount of blood loss. Sacral tumors that invaded cephalad to the S2-S3 disc space with a volume greater than 200 cm 3 and an excessive blood supply were likely to have a large amount of blood loss during resection.

Is Pre-Operative Angio-Embolisation an Effective Modality to Control Intraoperative Blood Loss in Extremity Bone Tumors?

“…Larger tumor size has been correlated with greater estimated blood loss (r= o.451; p< o.oo1) (29) . Tumor volumes greater than 200cm3 have been associated with lager amounts of intraoperative blood loss in sacral tumors (odds ratio 3.381) (36) . We have found pre-operative angio-embolization as a useful adjunct to operative intervention in malignant and metastatic bone tumors.…”

Blood Loss and Massive Transfusion in Patients Undergoing Major Oncological Surgery: What Do We Know?

“…Remarkably, almost 40% of the patients had a blood loss greater than 3,000 cc with a maximum blood loss of 37,000 cc [44,45]. Risk factors associated with an excessive blood loss are hypervascularity (odds ratio 2.281), tumor location at or cephalad to S2 region (odds ratio 3.84), and tumor volume greater than 200 cm 3 (odds ratio 3.381) [45,136]. Different pre-and intraoperative interventions have been described to reduce bleeding and related morbidity.…”

“…Reported estimated blood loss [38][39][40][41][42][43] 400-12,100 2-10 Sacral tumors [44][45][46] 3,000-37,000 0-43 Hemipelvectomy [47][48][49][50] 400-12,100 0-134 Total pelvic exenterations [47][48][49][50] 900-9,500 0-18 Nephrectomy with IVC embolectomy [37,[51][52][53][54][55] 200−16,000 0−91 Liver and multivisceral resection [12,[56][57][58][59][60][61][62] 200->5,000 0-44 Extrapleural pneumonectomies [63][64][65] 900-65,00 0-18 Table 1 illustrates ranges of blood losses and PRBCs of transfused units reported in the literature.…”

“…In a large series of patients, Fourney et al reported a 30-day complication rate of 61%. Unfortunately, significant intra-and postoperative blood loss (due to anatomic characteristics of the sacral region and the size of the tumors) is a common complication with average blood loss estimated between 2,922 cc and 6,300 cc [45,46,135]. Remarkably, almost 40% of the patients had a blood loss greater than 3,000 cc with a maximum blood loss of 37,000 cc [44,45].…”

“…Unfortunately, significant intra-and postoperative blood loss (due to anatomic characteristics of the sacral region and the size of the tumors) is a common complication with average blood loss estimated between 2,922 cc and 6,300 cc [45,46,135]. Remarkably, almost 40% of the patients had a blood loss greater than 3,000 cc with a maximum blood loss of 37,000 cc [44,45]. Risk factors associated with an excessive blood loss are hypervascularity (odds ratio 2.281), tumor location at or cephalad to S2 region (odds ratio 3.84), and tumor volume greater than 200 cm 3 (odds ratio 3.381) [45,136].…”