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Wu X, Huang Z, Lau WY, Li W, Lin P, Zhang L, Chen Y. Perioperative and long-term outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with well-preserved liver function and cirrhotic background: a propensity score matching study. Surg Endosc 2019; 33:206-215. [PMID: 29987565 DOI: 10.1007/s00464-018-6296-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 06/18/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although laparoscopic liver resection (LLR) has advanced into a safe and effective alternative to conventional open liver resection (OLR), it has not been widely accepted by surgeons. This article aimed to investigate the perioperative and long-term benefits of LLR versus OLR for hepatocellular carcinoma (HCC) in selected patients with well-preserved liver function and cirrhotic background. METHODS A retrospective study was conducted on 1085 patients with HCC who underwent liver resection at Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University from July 2010 to July 2015, and 346 patients with well-preserved liver function and cirrhotic background were selected. A 1:1 propensity score matching (PSM), which is the best option to overcome selection bias, was conducted to compare the surgical outcomes and long-term prognosis between LLR and OLR. After PSM, a logistic regression analysis was used to identify the predictive risk factors of posthepatectomy liver failure (PHLF). RESULTS By using PSM, the two groups were well balanced with 86 patients in each group. In the LLR group, only the median operation time was significantly longer than the OLR group, but the hospital stay, overall morbidity, and the incidence of PHLF were significantly decreased compared to OLR. There were no significant differences in the overall survival and disease-free survival rates between the two groups. On multivariate analysis, OLR was identified to be the only independent risk factor for PHLF. CONCLUSIONS In selected HCC patients with well-preserved liver function and cirrhotic background, LLR could be a better option compared to OLR.
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Affiliation(s)
- Xinqiang Wu
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Zejian Huang
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Wan Yee Lau
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China.,Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, People's Republic of China
| | - Wenda Li
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Pai Lin
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China
| | - Lei Zhang
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China.
| | - Yajin Chen
- Department of Hepato-biliary Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 Yanjiang West Road, Guangzhou, 510120, Guangdong, People's Republic of China.
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Abu-Ghanem Y, Ramon J. Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies. Ther Adv Urol 2019; 11:1756287219868054. [PMID: 31447936 PMCID: PMC6691668 DOI: 10.1177/1756287219868054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Centre, Tel-Hashomer, Ramat-Gan, 52621, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Centre, Ramat-Gan, Israel
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Zacharias T, Ahlschwede E, Dufour N, Romain F, Theissen-Laval O. Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy: a propensity-score-matched case-control analysis. Can J Surg 2018; 61:105-113. [PMID: 29582746 DOI: 10.1503/cjs.010017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver resection may be associated with substantial blood loss, and cell saver use has been recommended for patients at high risk. We performed a study to compare the allogenic erythrocyte transfusion rate after liver resection between patients who had intraoperative cell salvage with a cell saver device versus patients who did not. Our hypothesis was that cell salvage with autologous transfusion would reduce the allogenic blood transfusion rate. METHODS Cell salvage was used selectively in patients at high risk for intraoperative blood loss based on preoperatively known predictors: right and repeat hepatectomy. Patients who underwent elective right or repeat hepatectomy between Nov. 9, 2007, and Jan. 27, 2016 were considered for the study. Data were retrieved from a liver resection database and were analyzed retrospectively. Patients with cell saver use (since January 2013) constituted the experimental group, and those without cell salvage (2007-2012), the control group. To reduce selection bias, we matched propensity scores. The primary outcome was the allogenic blood transfusion rate within 90 days postoperatively. Secondary outcomes were the number of transfused erythrocyte units, and rates of overall and infectious complications. RESULTS Ninety-six patients were included in the study, 41 in the cell saver group and 55 in the control group. Of the 96, 64 (67%) could be matched, 32 in either group. The 2 groups were balanced for demographic and clinical variables. The allogenic blood transfusion rate was 28% (95% confidence interval [CI] 12.5%-43.7%) in the cell saver group versus 72% (95% CI 56.3%-87.5%) in the control group (p < 0.001). The overall and infectious complication rates were not significantly different between the 2 groups. CONCLUSION Intraoperative cell salvage with autologous transfusion in elective right or repeat hepatectomy reduced the allogenic blood transfusion rate.
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Affiliation(s)
- Thomas Zacharias
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Erich Ahlschwede
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Nicole Dufour
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Florence Romain
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
| | - Odile Theissen-Laval
- From the Service de chirurgie digestive, hépato-biliaire et endocrinienne, Pôle de Pathologies Digestives et Urologie (Zacharias); and the Pôle Anesthésie et Réanimation Chirurgicale, Hôpital Emile Muller, Mulhouse, France (Ahlschwede, Dufour, Romain, Theissen-Laval)
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Red blood cell transfusion and its alternatives in oncologic surgery-A critical evaluation. Crit Rev Oncol Hematol 2018; 134:1-9. [PMID: 30771868 DOI: 10.1016/j.critrevonc.2018.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/14/2018] [Accepted: 11/29/2018] [Indexed: 01/28/2023] Open
Abstract
Although blood transfusions have been used for more than 100 years and their potential to save lives is indisputable, there is still limited data on medium- and long-term outcomes after hemotherapy. Until recently, red blood cell transfusions represented the most commonly employed treatment for cancer anemia. As transfusions have been related to worse patient outcome in oncologic surgery, preventive strategies and alternative treatment approaches in the perioperative setting are warranted. This review aims to evaluate the evidence concerning the impact of transfusion on the course of malignant diseases with a focus on oncologic surgery and to provide a bundle of measures to improve patient care. The perioperative period is pivotal in determining long-term cancer outcome. An increasingly recognized area for improvement during this highly sensitive period is the treatment of anemia for three main reasons: Firstly, anemia has been recognized as an independent predictor of poor prognosis in cancer patients. Secondly, anemia is largely undertreated. Thirdly and probably most importantly, anemia therapy relied and often still relies heavily on red blood cell (RBC) transfusions, which may be an often suboptimal stopgap treatment. Perioperative RBC transfusions should be kept to a minimum due to growing concerns regarding the associated risks, which this review tries to clarify by providing an update of recent literature. This review furthermore discusses treatments for anemia and provides best-practice approaches to improve perioperative management of oncology patients undergoing surgery.
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Busti F, Marchi G, Ugolini S, Castagna A, Girelli D. Anemia and Iron Deficiency in Cancer Patients: Role of Iron Replacement Therapy. Pharmaceuticals (Basel) 2018; 11:E94. [PMID: 30274354 PMCID: PMC6315653 DOI: 10.3390/ph11040094] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 12/21/2022] Open
Abstract
Anemia in cancer patients is quite common, with remarkable negative impacts on quality of life and overall prognosis. The pathogenesis is complex and typically multifactorial, with iron deficiency (ID) often being a major and potentially treatable contributor. In turn, ID in cancer patients can be due to multiple concurring mechanisms, including bleeding (e.g., in gastrointestinal cancers or after surgery), malnutrition, medications, and hepcidin-driven iron sequestration into macrophages with subsequent iron-restricted erythropoiesis. Indeed, either absolute or functional iron deficiency (AID or FID) can occur. While for absolute ID there is a general consensus regarding the laboratory definition (that is ferritin levels <100 ng/mL ± transferrin saturation (TSAT) <20%), a shared definition of functional ID is still lacking. Current therapeutic options in cancer anemia include iron replacement, erythropoietic stimulating agents (ESAs), and blood transfusions. The latter should be kept to a minimum, because of concerns regarding risks, costs, and limited resources. Iron therapy has proved to be a valid approach to enhance efficacy of ESAs and to reduce transfusion need. Available guidelines focus mainly on patients with chemotherapy-associated anemia, and generally suggest intravenous (IV) iron when AID or FID is present. However, in the case of FID, the upper limit of ferritin in association with TSAT <20% at which iron should be prescribed is a matter of controversy, ranging up to 800 ng/mL. An increasingly recognized indication to IV iron in cancer patients is represented by preoperative anemia in elective oncologic surgery. In this setting, the primary goal of treatment is to decrease the need of blood transfusions in the perioperative period, rather than improving anemia-related symptoms as in chemotherapy-associated anemia. Protocols are mainly based on experiences of Patient Blood Management (PBM) in non-oncologic surgery, but no specific guidelines are available for oncologic surgery. Here we discuss some possible approaches to the management of ID in cancer patients in different clinical settings, based on current guidelines and recommendations, emphasizing the need for further research in the field.
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Affiliation(s)
- Fabiana Busti
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Giacomo Marchi
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Sara Ugolini
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Annalisa Castagna
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
| | - Domenico Girelli
- Department of Medicine, Section of Internal Medicine, University of Verona, and EuroBloodNet Referral Center for Iron Disorders, Azienda Ospedaliera Universitaria Integrata Verona, Policlinico G.B. Rossi, 37134 Verona, Italy.
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Krenzien F, Schmelzle M, Struecker B, Raschzok N, Benzing C, Jara M, Bahra M, Öllinger R, Sauer IM, Pascher A, Pratschke J, Andreou A. Liver Transplantation and Liver Resection for Cirrhotic Patients with Hepatocellular Carcinoma: Comparison of Long-Term Survivals. J Gastrointest Surg 2018; 22:840-848. [PMID: 29363019 DOI: 10.1007/s11605-018-3690-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 01/08/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Both liver transplantation (LT) and liver resection (LR) represent curative treatment options for hepatocellular carcinoma (HCC) in patients with liver cirrhosis. In this study, we have compared outcomes between historical and more recent patient cohorts scheduled either for LT or LR, respectively. METHODS Clinicopathological data of all patients with HCC and cirrhosis who underwent LT or LR between 1989 and 2011 were evaluated. Overall survival of patients with HCC within the Milan criteria (MC) was analyzed focusing on changes between different time periods. RESULTS In total, 364 and 141 patients underwent LT and LR for HCC in cirrhosis, respectively. Among patients with HCC within MC, 214 and 59 underwent LT and LR, respectively. Postoperative morbidity (37 vs. 11%, P < .0001), but not mortality (3 vs. 1%, P = .165), was higher after LR than after LT for HCC within MC. In the period 1989-2004, overall survival (OS) was significantly higher in patients who underwent LT compared to LR for HCC within MC (5-year OS: 77 vs. 36%, P < .0001). Interestingly, in the more recent period 2005-2011, OS was comparable between LT and LR for HCC within MC (5-year OS: 73 vs. 61%, P = .07). CONCLUSION We have noted an improvement of outcomes among patients selected for partial hepatectomy in recent years that were comparable to stable results after LT in cirrhotic patients with HCC. Whether those improvements are due to advances in liver surgery, optimized perioperative managament for patients with liver cirrhosis, and the development of modern multimodal treatment strategies for the recurrent lesions appears plausible.
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Affiliation(s)
- Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Benjamin Struecker
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Nathanael Raschzok
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Christian Benzing
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Maximilian Jara
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Bahra
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Igor M Sauer
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Pascher
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Andreas Andreou
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
- Berlin School of Integrative Oncology (BSIO), Berlin, Germany.
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Lyu X, Qiao W, Li D, Leng Y. Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis. Oncotarget 2018; 8:41740-41748. [PMID: 28410243 PMCID: PMC5522331 DOI: 10.18632/oncotarget.16771] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/09/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perioperative blood transfusion may be associated with negative clinical outcomes in oncological surgery. A meta-analysis of published studies was conducted to evaluate the impact of blood transfusion on short- and long-term outcomes following liver resection of colorectal liver metastasis (CLM). MATERIALS AND METHODS A systematic search was performed to identify relevant articles. Data were pooled for meta-analysis using Review Manager version 5.3. RESULTS Twenty-five observational studies containing 10621 patients were subjected to the analysis. Compared with non-transfused patients, transfused patients experienced higher overall morbidity (odds ratio [OR], 1.98; 95% confidence intervals [CI] =1.49-2.33), more major complications (OR, 2.12; 95% CI =1.26-3.58), higher mortality (OR, 4.13; 95% CI =1.96-8.72), and longer length of hospital stay (weighted mean difference, 4.43; 95% CI =1.15-7.69). Transfusion was associated with reduced overall survival (risk ratio [RR], 1.24, 95% CI =1.11-1.38) and disease-free survival (RR, 1.38, 95% CI=1.23-1.56). CONCLUSION Perioperative blood transfusion has a detrimental impact on the clinical outcomes of patients undergoing CLM resection.
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Affiliation(s)
- Xinghua Lyu
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wenhui Qiao
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Debang Li
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yufang Leng
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
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Lu Q, Lu JW, Wu Z, Liu XM, Li JH, Dong J, Yin GZ, Lv Y, Zhang XF. Perioperative outcome of elderly versus younger patients undergoing major hepatic or pancreatic surgery. Clin Interv Aging 2018; 13:133-141. [PMID: 29416321 PMCID: PMC5790074 DOI: 10.2147/cia.s153058] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective The aim of this study was to determine the safety of elderly cancer patients (≥70 years) undergoing hepatic resection (HR) or pancreaticoduodenectomy (PD) in comparison with younger adults (<70 years). Methods A total of 1,012 consecutive patients undergoing HR or PD were included. The incidence and severity of morbidity were documented within 30 days postoperatively and compared between elderly and younger groups. Risk factors associated with postoperative morbidity were investigated by multivariate logistic regression analysis. Results Elderly patients (n=111, 11.0%) had more comorbidities and worse preoperative general condition and liver function versus younger patients (n=901, 89.0%), and thus were more likely to develop infectious (eg, systemic sepsis and urinary tract infection, both p<0.01) and technical-associated complications (intraperitoneal bleeding and biliary/pancreatic fistula, p=0.029 and p=0.074, respectively). However, the incidence and severity of complications were comparable between elderly and younger patients in the whole cohort, and also in HR and PD surgery groups separately. Preoperative hemoglobin (odds ratio [OR] 1.4, p=0.007) and intraoperative blood transfusion (OR 1.9, p=0.002), rather than age, were independently associated with postoperative morbidity. Hepatitis (OR 2.9, p=0.001), preoperative hemoglobin (OR 1.6, p=0.036), and pancreatic versus hepatic surgery (OR 2.3, p=0.005) were independently associated with postoperative infectious. For elderly patients only, American Society of Anesthesiologists (ASA) score III (OR 2.1, p=0.033) and intraoperative blood transfusion (OR 3.2, p=0.030) were independently associated with postoperative morbidity. Conclusion HR and PD can be safely performed in selected elderly patients versus younger patients. Elderly patients with ASA score III or above should be cautiously selected for major surgeries.
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Affiliation(s)
- Qiang Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Jian-Wen Lu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Jian-Hui Li
- Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China.,Department of Surgical Oncology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jian Dong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Guo-Zhi Yin
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
| | - Xu-Feng Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center, Xi'an, Shaanxi, China
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Perioperative blood transfusion adversely affects prognosis after nephrectomy for renal cell carcinoma. Urol Oncol 2018; 36:12.e15-12.e20. [DOI: 10.1016/j.urolonc.2017.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/07/2017] [Accepted: 09/05/2017] [Indexed: 11/21/2022]
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Peng T, Zhao G, Wang L, Wu J, Cui H, Liang Y, Zhou R, Liu Z, Wang Q. No impact of perioperative blood transfusion on prognosis after curative resection for hepatocellular carcinoma: a propensity score matching analysis. Clin Transl Oncol 2017; 20:719-728. [DOI: 10.1007/s12094-017-1773-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/13/2017] [Indexed: 12/11/2022]
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Park SY, Seo KS, Karm MH. Perioperative red blood cell transfusion in orofacial surgery. J Dent Anesth Pain Med 2017; 17:163-181. [PMID: 29090247 PMCID: PMC5647818 DOI: 10.17245/jdapm.2017.17.3.163] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 08/24/2017] [Accepted: 09/03/2017] [Indexed: 01/28/2023] Open
Abstract
In the field of orofacial surgery, a red blood cell transfusion (RBCT) is occasionally required during double jaw and oral cancer surgery. However, the question remains whether the effect of RBCT during the perioperative period is beneficial or harmful. The answer to this question remains challenging. In the field of orofacial surgery, transfusion is performed for the purpose of oxygen transfer to hypoxic tissues and plasma volume expansion when there is bleeding. However, there are various risks, such as infectious complications (viral and bacterial), transfusion-related acute lung injury, ABO and non-ABO associated hemolytic transfusion reactions, febrile non-hemolytic transfusion reactions, transfusion associated graft-versus-host disease, transfusion associated circulatory overload, and hypersensitivity transfusion reaction including anaphylaxis and transfusion-related immune-modulation. Many studies and guidelines have suggested RBCT is considered when hemoglobin levels recorded are 7 g/dL for general patients and 8-9 g/dL for patients with cardiovascular disease or hemodynamically unstable patients. However, RBCT is occasionally an essential treatment during surgeries and it is often required in emergency cases. We need to comprehensively consider postoperative bleeding, different clinical situations, the level of intra- and postoperative patient monitoring, and various problems that may arise from a transfusion, in the perspective of patient safety. Since orofacial surgery has an especially high risk of bleeding due to the complex structures involved and the extensive vascular distribution, measures to prevent bleeding should be taken and the conditions for a transfusion should be optimized and appropriate in order to promote patient safety.
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Affiliation(s)
- So-Young Park
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
| | - Myong-Hwan Karm
- Department of Dental Anesthesiology, Seoul National University Dental Hospital, Seoul, Republic of Korea
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Hu L, Yao L, Li X, Jin P, Yang K, Guo T. Effectiveness and safety of robotic-assisted versus laparoscopic hepatectomy for liver neoplasms: A meta-analysis of retrospective studies. Asian J Surg 2017; 41:401-416. [PMID: 28912048 DOI: 10.1016/j.asjsur.2017.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/25/2017] [Indexed: 02/07/2023] Open
Abstract
This meta-analysis aimed to investigate the effectiveness and safety of RAH and LLR for liver neoplasms. A systematic search was performed in PubMed, EMbase, the Cochrane Library, Web of science, and China Biology Medicine disc up to July 2016 for studies that provided comparisons between the surgical outcomes of RAH and LLR for liver neoplasms. WMD, OR and 95% CI were calculated and data combined using the random-effect model. The quality of the evidence was assessed using GRADE methods. A total of 17 studies were included in the meta-analysis, in which 487 patients were in the RAH group and 902 patients were in the LLR group. The meta-analysis results indicated: compared to LLR, RAH was associated with more estimated blood loss, longer operative time, and longer time to first nutritional intake (p < 0.05). There was no significant difference in length of hospital stay, conversion rate during operation, R0 resection rate, complications and mortality (p > 0.05). Three studies reported the total cost, and the result showed a higher cost in the RAH group when compared with the LLR group (p < 0.05). This meta-analysis indicated that RAH and LLR display similar effectiveness and safety in hepatectomy. Considering the lack of high quality original studies, prospective clinical trials should be conducted to provide strong evidence for clinical guidelines formation, and the insurance coverage policies should be established to promote the application of robotic surgery in the future.
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Affiliation(s)
- Lidong Hu
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Liang Yao
- Institution of Clinical Research and Evidence Based Medicine, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Xiaofei Li
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China; Department of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, People's Republic of China
| | - Penghui Jin
- Department of Clinical Medicine, Gansu University of Traditional Chinese Medicine, Lanzhou 730000, People's Republic of China; Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, People's Republic of China.
| | - Tiankang Guo
- Department of General Surgery, Gansu Province People's Hospital, Lanzhou 730000, People's Republic of China.
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Owusu-Agyemang P, Zavala AM, Williams UU, Van Meter A, Soliz J, Kapoor R, Shah A, Hernandez M, Gottumukkala V, Cata JP. Assessing the impact of perioperative blood transfusions on the survival of adults undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy for appendiceal carcinomatosis. Vox Sang 2017; 112:567-577. [DOI: 10.1111/vox.12546] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 05/08/2017] [Accepted: 05/10/2017] [Indexed: 01/02/2023]
Affiliation(s)
- P. Owusu-Agyemang
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
- Anesthesiology and Surgical Oncology Research Group; Houston TX USA
| | - A. M. Zavala
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - U. U. Williams
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - A. Van Meter
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - J. Soliz
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - R. Kapoor
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - A. Shah
- The University of Texas Medical School; Houston TX USA
| | - M. Hernandez
- Department of Biostatistics; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - V. Gottumukkala
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - J. P. Cata
- Department of Anesthesiology and Perioperative Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
- Anesthesiology and Surgical Oncology Research Group; Houston TX USA
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Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today 2017; 48:73-79. [DOI: 10.1007/s00595-017-1553-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 05/22/2017] [Indexed: 02/08/2023]
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Gómez-Gavara C, Doussot A, Lim C, Salloum C, Lahat E, Fuks D, Farges O, Regimbeau JM, Azoulay D. Impact of intraoperative blood transfusion on short and long term outcomes after curative hepatectomy for intrahepatic cholangiocarcinoma: a propensity score matching analysis by the AFC-IHCC study group. HPB (Oxford) 2017; 19:411-420. [PMID: 28122668 DOI: 10.1016/j.hpb.2017.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 12/22/2016] [Accepted: 01/01/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND The impact of intraoperative blood transfusion (IBT) on outcomes following intrahepatic cholangiocarcinoma (IHCC) resection remains to be ascertained. METHODS All consecutive IHCC resected were analyzed. A first cohort (n = 569) was used for investigating short-term outcomes (morbidity and mortality). A second cohort (n = 522) excluding patients dead within 90 days of surgery was analyzed for exploring overall survival (OS) and disease free survival (DFS). Patients who received IBT were compared to those who did not, after using a propensity score matching (PSM) method. RESULTS Among 569 patients, 90-day morbidity and mortality rates were 47% (n = 269) and 8% (n = 47). After PSM, 208 patients were matched. There was an association between IBT and increased overall morbidity and severe morbidity (p = 0.010). However, IBT did not impact 90-day mortality rate (p > 0.999). Regarding long-term outcomes analysis in the second cohort (n = 522), 5-year OS and DFS rates were 39% and 25%. Using PSM, 196 patients were matched and no association between IBT and OS or DFS was found (p = 0.333 and p = 0.491). CONCLUSIONS IBT is associated with an increased risk of morbidity but does not impact on long-term outcomes. Need for IBT should be considered as a surrogate of advanced disease requiring complex resection. Still, restricted transfusion policy should remain advocated for IHCC resection.
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Affiliation(s)
- Concepción Gómez-Gavara
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Alexandre Doussot
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Chetana Lim
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Chady Salloum
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - Eylon Lahat
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France
| | - David Fuks
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - Olivier Farges
- Department of Hepatobiliary Surgery, AP-HP, Hôpital Beaujon, Clichy, France
| | | | - Daniel Azoulay
- Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France; INSERM, U955, Créteil, France.
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Bennett S, Baker LK, Martel G, Shorr R, Pawlik TM, Tinmouth A, McIsaac DI, Hébert PC, Karanicolas PJ, McIntyre L, Turgeon AF, Barkun J, Fergusson D. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford) 2017; 19:321-330. [PMID: 28161216 DOI: 10.1016/j.hpb.2016.12.008] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 12/16/2016] [Accepted: 12/30/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver resection is associated with a high proportion of red blood cell transfusions. There is a proposed association between perioperative transfusions and increased risk of complications and tumor recurrence. This study reviews the evidence of this association in the literature. METHODS The Medline, EMBASE, and Cochrane databases were searched for clinical trials or observational studies of patients undergoing liver resection that compared patients who did and did not receive a perioperative red blood cell transfusion. Outcomes were mortality, complications, and cancer survival. RESULTS Twenty-two studies involving 6832 patients were included. All studies were retrospective, with no clinical trials. No studies were scored as low risk of bias. The overall proportion of patients transfused was 38.3%. After multivariate analysis, 1 of 5 studies demonstrated an association between transfusion and increased mortality; 5 of 6 demonstrated an association between transfusion and increased complications; and 10 of 18 demonstrated an association between transfusion and decreased cancer survival. CONCLUSION This review supports the evidence linking perioperative blood transfusions to negative outcomes. The most convincing association was with post-operative complications, some association with long-term cancer outcomes, and no convincing association with mortality. These findings support the initiation, and further study, of restrictive transfusion protocols.
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Affiliation(s)
- Sean Bennett
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Laura K Baker
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada
| | - Guillaume Martel
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Columbus, OH, USA
| | - Alan Tinmouth
- The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel I McIsaac
- The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Anesthesiology, University of Ottawa, Ottawa, ON, Canada
| | - Paul C Hébert
- Department of Medicine, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | | | - Lauralyn McIntyre
- The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alexis F Turgeon
- Department of Anesthesiology, Université Laval, Québec, QC, Canada
| | - Jeffrey Barkun
- Department of Surgery, McGill University, Montréal, QC, Canada
| | - Dean Fergusson
- Department of Surgery, University of Ottawa, Ottawa, ON, Canada; The Ottawa Hospital, Ottawa, ON, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Murphree DH, Kinard TN, Khera N, Storlie CB, Ngufor C, Upadhyaya S, Pathak J, Fortune E, Jacob EK, Carter RE, Poterack KA, Kor DJ. Measuring the impact of ambulatory red blood cell transfusion on home functional status: study protocol for a pilot randomized controlled trial. Trials 2017; 18:153. [PMID: 28359342 PMCID: PMC5374599 DOI: 10.1186/s13063-017-1873-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 03/03/2017] [Indexed: 01/28/2023] Open
Abstract
Background Red blood cell (RBC) transfusion is frequently employed in both ambulatory and hospital environments with the aim of improving patient functional status. In the ambulatory setting, this practice is particularly common in patients with malignancy due to anemia associated with their cancer therapy. Increasingly, the efficacy of this US$10.5 billion per year practice has been called into question. While it is often standard of care for patients with chemotherapy-induced anemia to receive ambulatory RBC transfusions, it is unclear to what extent such transfusions affect home functional status. It is also unclear whether or not changes in functional status in this population can be objectively quantified using wearable activity monitors. We propose to directly measure the impact of outpatient RBC transfusions on at-home functional status by recording several physiological parameters and quantifiable physical activity metrics, e.g., daily energy expenditure and daily total step count, using the ActiGraph wGT3X-BT. This device is an accelerometer-based wearable activity monitor similar in size to a small watch and is worn at the waist. Study participants will wear the device during the course of their daily activities giving us quantifiable insight into activity levels in the home environment. Methods/design This will be a randomized crossover pilot clinical trial with a participant study duration of 28 days. The crossover nature allows each patient to serve as their own control. Briefly, patients presenting at a tertiary medical center’s Ambulatory Infusion Center (AIC) will be randomized to either: (1) receive an RBC transfusion as scheduled (transfusion) or (2) abstain from the scheduled transfusion (no transfusion). After an appropriate washout period, participants will crossover from the transfusion arm to the no-transfusion arm or vice versa. Activity levels will be recorded continuously throughout the study using an accelerometry monitor. In addition to device data, functional status and health outcomes will be collected via a weekly telephone interview. The primary outcome measure will be daily energy expenditure. Performance metrics, such as step count changes, will also be evaluated. Additional secondary outcome measures will include daily sedentary time and Patient-reported Outcomes Measurement Information System (PROMIS) Global 10 Survey scores. Discussion This trial will provide important information on the feasibility and utility of using accelerometry monitors to directly assess the impact of RBC transfusion on patients’ functional status. The results of the study will inform the merit and methods of a more definitive future trial evaluating the impact of ambulatory RBC transfusions in the target population. Trial registration ClinicalTrials.gov, identifier: NCT02835937. Registered on 15 July 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1873-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dennis H Murphree
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
| | - Theresa N Kinard
- Department of Pathology and Laboratory Medicine, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Nandita Khera
- Department of Hematology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Curtis B Storlie
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Che Ngufor
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Jyotishman Pathak
- Division of Health Informatics, Weill Cornell Medical College, 425 East 61 Street, New York, NY, 10065, USA
| | - Emma Fortune
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Eapen K Jacob
- Division of Hematology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Karl A Poterack
- Department of Anesthesiology, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Daryl J Kor
- Department of Anesthesiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
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Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study. World J Urol 2017; 35:1435-1442. [DOI: 10.1007/s00345-017-2009-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/24/2017] [Indexed: 12/31/2022] Open
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Ryckx A, Christiaens C, Clarysse M, Vansteenkiste F, Steelant PJ, Sergeant G, Parmentier I, Pottel H, D'Hondt M. Central Venous Pressure Drop After Hypovolemic Phlebotomy is a Strong Independent Predictor of Intraoperative Blood Loss During Liver Resection. Ann Surg Oncol 2017; 24:1367-1375. [PMID: 28054191 DOI: 10.1245/s10434-016-5737-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intraoperative hypovolemic phlebotomy (HP) has been suggested to reduce central venous pressure (CVP) before hepatectomy. This study aimed to analyze the impact of CVP drop after HP on intraoperative blood loss and postoperative renal function. METHODS A retrospective review of a prospective database including 100 consecutive patients (43 males and 57 females; mean age, 65 years; range 23-89 years) undergoing liver resection with HP was performed. The primary outcome variable was estimated blood loss (EBL), and the secondary outcome was postoperative serum creatinin (Scr). A multivariate linear regression analysis was performed to identify predictors of intraoperative blood loss. RESULTS The median CVP before blood salvage was 8 mmHg (range 4-30 mmHg). The median volume of hypovolemic phlebotomy was 400 ml (range 200-1000 ml). After HP, CVP decreased to a median of 3 mmHg (range -2 to 16 mmHg), resulting in a median CVP drop of 5.5 mmHg (range 2-14 mmHg). The median EBL during liver resection was 165 ml (range 0-800 ml). The median preoperative serum creatinin (Scr) was 0.82 g/dl (range 0.5-1.74 g/dl), and the postoperative Scr on day 1 was 0.74 g/dl (range 0.44-1.68 g/dl). The CVP drop was associated with EBL (P < 0.001). There was no significant impact of CVP drop on postoperative Scr. CONCLUSION A CVP drop after HP is a strong independent predictor of EBL during liver resection. The authors advocate the routine use of HP to reduce perioperative blood loss and transfusion rates in liver surgery. As a predictive tool, CVP drop might help surgeons decide whether a laparoscopic approach is safe.
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Affiliation(s)
- Andries Ryckx
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | | | - Mathias Clarysse
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | - Franky Vansteenkiste
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium
| | | | - Gregory Sergeant
- Department of Abdominal and Hepatobiliary Surgery, Jessa Hospital, Hasselt, Belgium
| | - Isabelle Parmentier
- Department of Oncology and Statistics, Groeninge Hospital, Kortrijk, Belgium
| | - Hans Pottel
- Interdisciplinary Research Center, Leuven University Campus, Kortrijk, Belgium
| | - Mathieu D'Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital, Kortrijk, Belgium.
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Nichols CI, Vose JG. Use of a saline-coupled bipolar sealer open liver resection for hepatic malignancy: Medical resource use and costs. World J Gastroenterol 2016; 22:10189-10197. [PMID: 28028367 PMCID: PMC5155178 DOI: 10.3748/wjg.v22.i46.10189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/11/2016] [Accepted: 11/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate outcomes associated with use of a saline coupled bipolar sealer during open partial liver resection.
METHODS This retrospective analysis utilized the United States Premier™ insurance claims database (2010-2014). Patients were selected with codes for liver malignancy and partial hepatectomy or lobectomy. Cases were defined by use the saline-coupled bipolar sealer; controls had no use. A Propensity Score algorithm was used to match one case to five controls. A deviation-based cost modeling (DBCM) approach provided an estimate of cost-effectiveness.
RESULTS One hundred and forty-four cases and 720 controls were available for analysis. Patients in the case cohort received fewer transfusions vs controls (18.1% vs 29.4%, P = 0.007). In DBCM, more patients in the case cohort experienced “on-course” hospitalizations (53.5% vs 41.9%, P = 0.009). The cost calculation showed an average savings in total hospitalization costs of $1027 for cases vs controls. In multivariate analysis, cases had lower odds of receiving a transfusion (OR = 0.44, 95%CI: 0.27-0.71, P = 0.0008).
CONCLUSION Use of a saline-coupled bipolar sealer was associated with a greater proportion of patients with an “on course” hospitalization.
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Perioperative blood transfusion and the clinical outcomes of patients undergoing cholangiocarcinoma surgery: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28:1233-40. [PMID: 27560845 DOI: 10.1097/meg.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several studies have reported different results on the association between perioperative blood transfusion (PBT) and clinical outcomes for patients undergoing cholangiocarcinoma surgery. So far, no systematic review and meta-analysis have focused on this inconsistent issue. Therefore, we carried out a systematic review and meta-analysis to evaluate the association between PBT and the clinical outcomes of cholangiocarcinoma surgery patients. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched from their inception to 6 April 2016 to evaluate the relationship between PBT and clinical outcomes for patients undergoing cholangiocarcinoma surgery. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the Cochrane Collaboration's RevMan 5.3 software. A total of 10 studies (1719 patients) were included in the meta-analysis. Pooled analysis showed that PBT was associated with worse 5-year survival rate (HR=1.67, 95% CI=1.41-1.98, P<0.0001) and median overall survival (OS) (HR=1.45, 95% CI=1.14-1.83, P=0.002) in the patients who underwent cholangiocarcinoma surgery. Subgroup analysis showed that intraoperative blood transfusion was also associated with worse 5-year survival rate (HR=1.95, 95% CI=1.49-2.57, P<0.00001). Intraoperative blood transfusion is associated with poor OS for patients undergoing cholangiocarcinoma surgery because it will increase the risk of death. Postoperative blood transfusion may not be associated with OS. In addition, the relationship between PBT and the postoperative complication rate of cholangiocarcinoma surgery is still unclear.
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Fawley J, Chelius TH, Anderson Y, Cassidy LD, Arca MJ. Relationship between perioperative blood transfusion and surgical site infections in the newborn population: An ACS-NSQIP-Pediatrics analysis. J Pediatr Surg 2016; 51:1397-404. [PMID: 27325358 DOI: 10.1016/j.jpedsurg.2016.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 05/01/2016] [Accepted: 05/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Adult data suggest that perioperative transfusion may have deleterious effects through immunomodulation. Limited data regarding the effect of transfusions exist in the pediatric population. We hypothesized that perioperative transfusions may be associated with surgical site infections (SSI) in newborns. METHODS The 2012 and 2013 American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files were queried to include all neonates that underwent surgical procedures. SSI rates in infants who had a perioperative blood transfusion were compared to those who were not transfused using a Fisher's Exact Test. Logistic regression analysis compared the odds of SSIs in transfused patients versus nontransfused patients. p Values <0.05 were statistically significant. RESULTS The study population included 6499 patients, of which 1109 (17.1%) had transfusions. Transfused patients had increased SSIs. In the multivariate analysis, patients with nutritional issues (OR=1.58, 95%CI 1.24-2.00), current infection (OR=1.98, 95%CI 1.52-2.57), and perioperative transfusion (OR=2.08, 95%CI 1.59-2.72) were associated with increased risk of SSI after controlling for all other variables. CONCLUSIONS Perioperative transfusions are associated with increased risk of SSIs. Further work to determine possible mechanisms of this association may be warranted.
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Affiliation(s)
- Jason Fawley
- Loma Linda University, 11175 Campus Street, #21108, Loma Linda, CA, USA
| | - Thomas H Chelius
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Yvonne Anderson
- Children's Hospital of Wisconsin, 999 N 92nd Street Suite 320, Milwaukee, WI, USA
| | - Laura D Cassidy
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA
| | - Marjorie J Arca
- Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, USA; Children's Hospital of Wisconsin, 999 N 92nd Street Suite 320, Milwaukee, WI, USA.
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Zhong JH, Xiang BD, Li LQ. Blood transfusion and postoperative complications: a cautionary comment. Transl Gastroenterol Hepatol 2016; 1:57. [PMID: 28138624 DOI: 10.21037/tgh.2016.06.09] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 06/30/2016] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Bang-De Xiang
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
| | - Le-Qun Li
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, China
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Pretreatment Neutrophil to Lymphocyte Ratio Independently Predicts Disease-specific Survival in Resectable Gastroesophageal Junction and Gastric Adenocarcinoma. Ann Surg 2016; 263:292-7. [PMID: 25915915 DOI: 10.1097/sla.0000000000001189] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Preoperative methods to estimate disease-specific survival (DSS) for resectable gastroesophageal (GE) junction and gastric adenocarcinoma are limited. We evaluated the relationship between DSS and pretreatment neutrophil to lymphocyte ratio (NLR). BACKGROUND The patient's inflammatory state is thought to be associated with oncologic outcomes, and NLR has been used as a simple and convenient marker for the systemic inflammatory response. Previous studies have suggested that NLR is associated with cancer-specific outcomes. METHODS A retrospective review of a prospectively maintained institutional database was undertaken to identify patients who underwent potentially curative resection for GE junction and gastric adenocarcinoma from 1998 to 2013. Clinicopathologic findings, pretreatment leukocyte values, and follow-up status were recorded. The Kaplan-Meier method was used to estimate DSS, and Cox proportional hazards models were used to evaluate the association between variables and DSS. RESULTS We identified 1498 patients who fulfilled our eligibility criteria. Univariate analysis showed that male sex, Caucasian race, increased T and N stage, GE junction location, moderate/poor differentiation, nonintestinal Lauren histology, and vascular and perineural invasion were associated with worse DSS. Elevated NLR was also associated with worse DSS [hazard ratio (HR) = 1.11; 95% CI: 1.08-1.14; P < 0.01]. On multivariate analysis, pretreatment NLR as a continuous variable was a highly significant independent predictor of DSS. For every unit increase in NLR, the risk of cancer-associated death increases by approximately 10% (HR = 1.10; 95% CI: 1.05-1.13; P < 0.0001). CONCLUSIONS In patients with resectable GE junction and gastric adenocarcinoma, pretreatment NLR independently predicts DSS. This and other clinical variables can be used in conjunction with cross-sectional imaging and endoscopic ultrasound as part of the preoperative risk stratification process.
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Wang SY, Lei GL, Sun JY, Liu J, Liu ZG. Effect of perioperative blood transfusion on postoperative complications after liver transplantation. Shijie Huaren Xiaohua Zazhi 2016; 24:1891-1897. [DOI: 10.11569/wcjd.v24.i12.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of perioperative blood transfusion on complications after liver transplantation.
METHODS: In order to analyze the relationship between blood transfusion and complications after liver transplantation, the clinical data for 418 patients who underwent liver transplantation from January 1, 2005 to December 31, 2012 at our hospital were analyzed retrospectively.
RESULTS: Of 386 liver transplantation patients, 235 (60.88%) developed postoperative complications and 151 (39.12%) did not occur. The main early complications were lung infection, electrolyte disturbance and reperfusion injury. As the frequency and amount of blood transfused increased, the incidence of complications increased.
CONCLUSION: The higher the frequency and amount of perioperative blood transfusion after liver transplantation, the higher the incidence of complications including infection, electrolyte imbalance, reperfusion injury and so on. Therefore, perioperative blood transfusion should be minimized.
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Goubran HA, Elemary M, Radosevich M, Seghatchian J, El-Ekiaby M, Burnouf T. Impact of Transfusion on Cancer Growth and Outcome. CANCER GROWTH AND METASTASIS 2016; 9:1-8. [PMID: 27006592 PMCID: PMC4790595 DOI: 10.4137/cgm.s32797] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/01/2016] [Accepted: 02/03/2016] [Indexed: 12/21/2022]
Abstract
For many years, transfusion of allogeneic red blood cells, platelet concentrates, and plasma units has been part of the standard therapeutic arsenal used along the surgical and nonsurgical treatment of patients with malignancies. Although the benefits of these blood products are not a matter of debate in specific pathological conditions associated with life-threatening low blood cell counts or bleeding, increasing clinical evidence is nevertheless suggesting that deliberate transfusion of these blood components may actually lead to negative clinical outcomes by affecting patient’s immune defense, stimulating tumor growth, tethering, and dissemination. Rigorous preclinical and clinical studies are needed to dimension the clinical relevance, benefits, and risks of transfusion of blood components in cancer patients and understand the amplitude of problems. There is also a need to consider validating preparation methods of blood components for so far ignored biological markers, such as microparticles and biological response modifiers. Meanwhile, blood component transfusions should be regarded as a personalized medicine, taking into careful consideration the status and specificities of the patient, rather than as a routine hospital procedure.
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Affiliation(s)
- Hadi A Goubran
- Saskatoon Cancer Centre, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Mohamed Elemary
- Saskatoon Cancer Centre, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/Safety, Audit/Inspection and DDR Strategies, London, UK
| | | | - Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
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79
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Yang T, Lu JH, Lau WY, Zhang TY, Zhang H, Shen YN, Alshebeeb K, Wu MC, Schwartz M, Shen F. Perioperative blood transfusion does not influence recurrence-free and overall survivals after curative resection for hepatocellular carcinoma: A Propensity Score Matching Analysis. J Hepatol 2016; 64:583-93. [PMID: 26596543 DOI: 10.1016/j.jhep.2015.10.012] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 10/12/2015] [Accepted: 10/13/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Whether perioperative blood transfusions (PBTs) negatively impact oncologic outcomes after curative resection for HCC remains controversial. We aimed to identify the independent predictive factors of PBT for curative resection of hepatocellular carcinoma (HCC), and to investigate the impact of PBT on long-term recurrence and survivals after resection. METHODS Of 1103 patients who underwent curative liver resection for HCC between 1999 and 2010, 285 (25.8%) patients received PBT. Univariable and multivariable regression analyses were used to identify independent predictive factors of PBT. Propensity scores and Cox regression analyses were used to compare the overall survival (OS) and recurrence-free survival (RFS) between patients who did and did not receive PBT. RESULTS Multivariable regression analysis revealed that performance status, preoperative hemoglobin, cirrhosis, portal hypertension, tumor rupture, tumor size, macroscopic vascular invasion, and intraoperative blood loss were independent predictive factors of PBT for HCC resection. Propensity score matching analysis created 234 pairs of patients. Before propensity matching, PBT was significantly associated with increased risks of OS (HR: 2.455, 95% CI: 2.077-2.901, p<0.001) and RFS (HR: 2.018, 95% CI: 1.718-2.370, p<0.001) in the entire cohort. After propensity matching, PBT was not significantly associated with increased risks of OS (HR: 1.229, 95% CI: 0.988-1.527, p=0.063) and RFS (HR: 1.188, 95% CI: 0.960-1.469, p=0.113). After adjustment for other prognostic variables in the propensity matched cohort, PBT was still found not to be associated with OS and RFS after HCC resection. CONCLUSIONS The present study identified that PBT did not influence RFS and OS after curative resection of HCC.
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Affiliation(s)
- Tian Yang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Liver Cancer Program, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Jun-Hua Lu
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wan Yee Lau
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region
| | - Tian-Yi Zhang
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Han Zhang
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yi-Nan Shen
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Kutaiba Alshebeeb
- Liver Cancer Program, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA
| | - Meng-Chao Wu
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Myron Schwartz
- Liver Cancer Program, Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York 10029, NY, USA.
| | - Feng Shen
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
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80
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Bennett S, Baker L, Shorr R, Martel G, Fergusson D. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review protocol. Syst Rev 2016; 5:38. [PMID: 26926289 PMCID: PMC4770706 DOI: 10.1186/s13643-016-0217-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/22/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Liver resection is commonly performed for malignant and benign disease and is associated with frequent use of intraoperative and postoperative blood transfusions. Blood transfusions are potentially life-saving, but they have many adverse effects; some well understood, and others less so. Some of the poorly understood side effects include increased risk of postoperative complications and possibly worse oncologic outcomes. The objective of this systematic review is to provide estimates of transfusion prevalence and the effects of perioperative blood transfusion on postoperative mortality and morbidity and long-term cancer outcomes in patients undergoing liver resection. METHODS/DESIGN The Cochrane, Medline, and EMBASE databases will be searched for any randomized controlled trial or observational cohort study comparing liver resection patients that received intraoperative or postoperative allogeneic red blood cell transfusions to those who did not. Outcomes include postoperative mortality, postoperative morbidity (infectious, liver failure, renal failure, cardiovascular/cerebrovascular events, and thromboembolic events), and long-term disease-free and overall survival. Only studies with adult, human patients (>18 years old) undergoing liver resection, in which the primary intervention of interest is blood transfusion will be included. Data will be extracted by two reviewers in duplicate and synthesized into a narrative review. Risk of bias will be assessed. When clinically and methodologically appropriate, meta-analysis will be performed. DISCUSSION Our review will synthesize the literature pertaining to the potential beneficial and detrimental effects of red blood cell transfusion in patients undergoing liver resection. It will be an important step in the development of guidelines for the appropriate use of blood transfusions in patients undergoing liver resection. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015026132.
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Affiliation(s)
- Sean Bennett
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
| | - Laura Baker
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
| | - Risa Shorr
- The Ottawa Hospital, Ottawa, ON, Canada.
| | - Guillaume Martel
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
| | - Dean Fergusson
- Division of General Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
- The Ottawa Hospital, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Center for Practice Changing Research Building, The Ottawa Hospital-General Campus, 501 Smyth Road, PO Box 201B, Ottawa, Ontario, Canada.
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81
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Araujo RLC, Pantanali CA, Haddad L, Filho JAR, D’Albuquerque LAC, Andraus W. Does autologous blood transfusion during liver transplantation for hepatocellular carcinoma increase risk of recurrence? World J Gastrointest Surg 2016; 8:161-168. [PMID: 26981190 PMCID: PMC4770170 DOI: 10.4240/wjgs.v8.i2.161] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 10/10/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023] Open
Abstract
AIM: To analyze outcomes in patients who underwent liver transplantation (LT) for hepatocellular carcinoma (HCC) and received autologous intraoperative blood salvage (IBS).
METHODS: Consecutive HCC patients who underwent LT were studied retrospectively and analyzed according to the use of IBS or not. Demographic and surgical data were collected from a departmental prospective maintained database. Statistical analyses were performed using the Fisher’s exact test and the Wilcoxon rank sum test to examine covariate differences between patients who underwent IBS and those who did not. Univariate and multivariate Cox regression models were developed to evaluate recurrence and death, and survival probabilities were estimated using the Kaplan-Meier method and compared by the log-rank test.
RESULTS: Between 2002 and 2012, 158 consecutive patients who underwent LT in the same medical center and by the same surgical team were identified. Among these patients, 122 (77.2%) were in the IBS group and 36 (22.8%) in the non-IBS group. The overall survival (OS) and recurrence free survival (RFS) at 5 years were 59.7% and 83.3%, respectively. No differences in OS (P = 0.51) or RFS (P = 0.953) were detected between the IBS and non-IBS groups. On multivariate analysis for OS, degree of tumor differentiation remained as the only independent predictor. Regarding patients who received IBS, no differences were detected in OS or RFS (P = 0.055 and P = 0.512, respectively) according to the volume infused, even when outcomes at 90 d or longer were analyzed separately (P = 0.518 for both outcomes).
CONCLUSION: No differences in RFS or OS were detected according to IBS use. Trials addressing this question are justified and should be designed to detect small differences in long-term outcomes.
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82
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Are We Sure that Blood Transfusion is Associated with Recurrence of Hepatocellular Carcinoma After Hepatectomy? World J Surg 2016; 40:2291-2. [PMID: 26902634 DOI: 10.1007/s00268-016-3464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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83
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Tsai HW, Hsieh FC, Chang CC, Su MJ, Chu FY, Chen KH, Jeng KS, Chen Y. Clinical Practice of Blood Transfusion in Orthotopic Organ Transplantation: A Single Institution Experience. Asian Pac J Cancer Prev 2015; 16:8009-13. [DOI: 10.7314/apjcp.2015.16.17.8009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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84
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Fahrner R, Dondorf F, Ardelt M, Dittmar Y, Settmacher U, Rauchfuß F. Liver transplantation for hepatocellular carcinoma - factors influencing outcome and disease-free survival. World J Gastroenterol 2015; 21:12071-12082. [PMID: 26576092 PMCID: PMC4641125 DOI: 10.3748/wjg.v21.i42.12071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.
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85
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Wehry J, Agle S, Philips P, Cannon R, Scoggins CR, Puffer L, McMasters KM, Martin RCG. Restrictive blood transfusion protocol in malignant upper gastrointestinal and pancreatic resections patients reduces blood transfusions with no increase in patient morbidity. Am J Surg 2015; 210:1197-204; discussion 1204-5. [PMID: 26602534 DOI: 10.1016/j.amjsurg.2015.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/10/2015] [Accepted: 08/12/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study was to determine the impact of a restrictive blood transfusion protocol on the number of transfusions performed and the related effect on patient morbidity. METHODS A cohort study was performed using our prospective database with information from January 1, 2000, to June 1, 2013. The restrictive blood transfusion protocol was implemented in September 2011, so this date served as the separation point for the date of operation criteria. RESULTS For the study, 415 patients undergoing operation for an abdominal malignancy were reviewed. After the restrictive blood transfusion protocol, the percentage of patients who received blood dropped from 35.6% to 28.3%. The percentage of patients who experienced perioperative complication was significantly higher in transfused patients compared with those who did not receive blood (P = .0001). There was no statistical significance observed between the 5 groups for the length of stay at the hospital after their procedure. CONCLUSIONS The restrictive blood transfusion protocol resulted in a reduction of the percentage of patients transfused, and there was no evidence to suggest that it negatively affected the outcomes of patients in this group.
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Affiliation(s)
- John Wehry
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Steven Agle
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Prejesh Philips
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Robert Cannon
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Charles R Scoggins
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Lisa Puffer
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Kelly M McMasters
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA
| | - Robert C G Martin
- Division of Surgical Oncology, Department of Surgery, University of Louisville, 315 East Broadway #312, Louisville, KY, 40202, USA.
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86
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Wang YL, Jiang B, Yin FF, Shi HQ, Xu XD, Zheng SS, Wu S, Hou SC. Perioperative Blood Transfusion Promotes Worse Outcomes of Bladder Cancer after Radical Cystectomy: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0130122. [PMID: 26080092 PMCID: PMC4469696 DOI: 10.1371/journal.pone.0130122] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 05/18/2015] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Multiple studies have investigated the effect of perioperative blood transfusion (PBT) for patients with radical cystectomy (RC), but the results have been inconsistent. We conducted a systematic review and meta-analysis to investigate the relationship between PBT and the clinical outcomes of RC patients. METHODS We searched MEDLINE, EMBASE, the Cochrane library and BIOSIS previews to identify relevant literature for studies that focused on the relationship of PBT and outcomes of patients undergoing RC. A fixed or random effects model was used in this meta-analysis to calculate the pooled hazard ratio (HR) with 95% confidence intervals (CIs). RESULTS A total of 7080 patients in 6 studies matched the selection criteria. Aggregation of the data suggested that PBT in patients who underwent RC correlated with increased all-cause mortality, cancer-specific mortality and cancer recurrence. The combined HRs were 1.19 (n = 6 studies, 95% CI: 1.11-1.27, Z = 4.71, P<0.00001), 1.17 (n = 4 studies, 95% CI: 1.06-1.30, Z = 3.06, P = 0.002), 1.14 (n = 3 studies, 95% CI: 1.03-1.27, Z = 2.50, P = 0.01), respectively. The all-cause mortality associated with PBT did not vary by the characteristics of the study, including number of study participants, follow-up period and the median blood transfusion ratio of the study. CONCLUSION Our data showed that PBT significantly increased the risks of all-cause mortality, cancer-specific mortality and cancer recurrence in patients undergoing RC for bladder cancer.
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Affiliation(s)
- You-Lin Wang
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Bo Jiang
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Fu-Fen Yin
- Department of Obstetrics and Gynecology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Hao-Qing Shi
- Department of Urology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Xiao-Dong Xu
- Department of Urology, Affiliate Hospital of Qingdao University, Qingdao, China
| | - Shuai-Shuai Zheng
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Shuai Wu
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
| | - Si-Chuan Hou
- Department of Urology, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, China
- Department of Urology, Qingdao Municipal Hospital, Dalian Medical University, Dalian, China
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Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma. J Gastrointest Surg 2015; 19:1194-5. [PMID: 25895979 DOI: 10.1007/s11605-015-2823-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/07/2015] [Indexed: 01/31/2023]
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88
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2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma. Gut Liver 2015; 9:267-317. [PMID: 25918260 PMCID: PMC4413964 DOI: 10.5009/gnl14460] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 03/09/2015] [Indexed: 12/23/2022] Open
Abstract
The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
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89
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2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 2015; 16:465-522. [PMID: 25995680 PMCID: PMC4435981 DOI: 10.3348/kjr.2015.16.3.465] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 04/02/2015] [Indexed: 02/07/2023] Open
Abstract
The guideline for the management of hepatocellular carcinoma (HCC) was first developed in 2003 and revised in 2009 by the Korean Liver Cancer Study Group and the National Cancer Center, Korea. Since then, many studies on HCC have been carried out in Korea and other countries. In particular, a substantial body of knowledge has been accumulated on diagnosis, staging, and treatment specific to Asian characteristics, especially Koreans, prompting the proposal of new strategies. Accordingly, the new guideline presented herein was developed on the basis of recent evidence and expert opinions. The primary targets of this guideline are patients with suspicious or newly diagnosed HCC. This guideline provides recommendations for the initial treatment of patients with newly diagnosed HCC.
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90
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He W, Zeng Q, Zheng Y, Chen M, Shen J, Qiu J, Chen M, Zou R, Liao Y, Li Q, Wu X, Li B, Yuan Y. The role of clinically significant portal hypertension in hepatic resection for hepatocellular carcinoma patients: a propensity score matching analysis. BMC Cancer 2015; 15:263. [PMID: 25886495 PMCID: PMC4399206 DOI: 10.1186/s12885-015-1280-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 03/27/2015] [Indexed: 12/15/2022] Open
Abstract
Background Whether portal hypertension (PHT) is an appropriate contraindication for hepatic resection (HR) in hepatocellular carcinoma (HCC) patient is still under debate. Aims: Our aim was to assess the impact of clinically significant PHT on postoperative complication and prognosis in HCC patients who undergo HR. Methods Two hundred and nine HCC patients who underwent HR as the initial treatment were divided into two groups according to the presence (n = 102) or absence (n = 107) of clinically significant PHT. Propensity score matching (PSM) analysis was used to compare postoperative outcomes and survival. Results Before PSM, PHT patients had higher rates of postoperative complication (43.1% vs. 23.4%; P = 0.002) and liver decompensation (37.3% vs. 17.8%; P = 0.002) with similar rates of recurrence-free survival (RFS; P = 0.369) and overall survival (OS; P = 0.205) compared with that of non-PHT patients. However, repeat analysis following PSM revealed similar rates of postoperative complication (32.2% vs. 39.0%; P = 0.442), liver decompensation (25.4% vs. 32.2%; P = 0.416), RFS (P = 0.481) and OS (P = 0.417; 59 patients in each group). Presence of PHT was not associated with complication by logistic regression analysis, or with overall survival by Cox regression analysis. Conclusions The presence of clinically significant PHT had no impact on postoperative complication and prognosis, and should not be regarded as a contraindication for HR in HCC patients.
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Affiliation(s)
- Wei He
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Qingli Zeng
- Department of Surgery, People's Hospital of Jiangxi Province, Nanchang, China.
| | - Yun Zheng
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Meixian Chen
- Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Jingxian Shen
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Medical Imaging and Interventional Center, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Jiliang Qiu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Miao Chen
- Department of Surgery, People's Hospital of Jiangxi Province, Nanchang, China.
| | - Ruhai Zou
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Ultrasound, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Yadi Liao
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Qijiong Li
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Xianqiu Wu
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Binkui Li
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
| | - Yunfei Yuan
- State Key Laboratory of Oncology in South China and Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, China. .,Department of Hepatobiliary Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China.
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91
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Bergeat D, Sulpice L, Rayar M, Edeline J, Merdignac A, Meunier B, Boucher E, Boudjema K. Extended liver resections for intrahepatic cholangiocarcinoma: Friend or foe? Surgery 2015; 157:656-65. [DOI: 10.1016/j.surg.2014.11.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/26/2014] [Accepted: 11/17/2014] [Indexed: 12/27/2022]
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92
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Vamvakas EC. Allogeneic blood transfusion and cancer recurrence: 20 years later. Transfusion 2015; 54:2149-53. [PMID: 25212422 DOI: 10.1111/trf.12689] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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93
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Abstract
Cancer patients are commonly transfused with blood products immediately before, during or after major surgery. Blood loss and haemodilution are the most common causes of red blood cells (RBCs) administration and coagulopathies are the indications for the infusion of fresh-frozen plasma (FFP), cryoprecipitates and platelets. Transfusion-related immune modulation is a complication associated with the administration of blood products. A decreased immune surveillance as a consequence of blood transfusions has been linked to cancer recurrence and progression. Moreover, soluble factors present in packed RBCs, platelets and FFP can directly stimulate tumour growth and spread. Two meta-analyses suggest that the administration of blood products is associated with shorter recurrence-free survival and overall survival after colorectal cancer surgery. More studies are needed to show such association in different cancer patient populations.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA ; Outcomes Research Consortium, USA
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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94
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Huang J, Tang W, Hernandez-Alejandro R, Bertens KA, Wu H, Liao M, Li J, Zeng Y. Intermittent hepatic inflow occlusion during partial hepatectomy for hepatocellular carcinoma does not shorten overall survival or increase the likelihood of tumor recurrence. Medicine (Baltimore) 2014; 93:e288. [PMID: 25526466 PMCID: PMC4603114 DOI: 10.1097/md.0000000000000288] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate whether the long-term outcomes of hepatocellular carcinoma (HCC) was adversely impacted by intermittent hepatic inflow occlusion (HIO) during hepatic resection. METHODS 1549 HCC patients who underwent hepatic resection between 1998 and 2008 were identified from a prospectively maintained database. Intermittent HIO was performed in 931 patients (HIO group); of which 712 patients had a Pringle maneuver as the mechanism for occlusion (PM group), and 219 patients had selective hemi-hepatic occlusion (SO group). There were 618 patients that underwent partial hepatectomy without occlusion (occlusion-free, OF group). RESULTS The 1-, 3-, and 5- year overall survival (OS) rates were 79%, 59%, and 42% in the HIO group, and 83%, 53%, and 35% in the OF group, respectively. The corresponding recurrence free survival (RFS) rates were 68%, 39%, and 22% in the HIO group, and 74%, 41%, and 18% in the OF group, respectively. There was no significant difference between the 2 groups in OS or RFS (P=0.325 and P=0.416). Subgroup analysis showed patients with blood loss over 3000 mL and those requiring transfusion suffered significantly shorter OS and RFS. Blood loss over 3000 mL and blood transfusion were independent risk factors to OS and RFS. CONCLUSIONS The application of intermittent HIO (PM and SO) during hepatic resection did not adversely impact either OS or RFS in patients with HCC. Intermittent HIO is still a valuable tool in hepatic resection, because high intraoperative blood loss resulting in transfusion is associated with a reduction in both OS and RFS.
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Affiliation(s)
- Jiwei Huang
- From the Department of Liver Surgery, Division of Liver Transplantation, West China Hospital, Sichuan University, Chengdu, China (JH, HW, ML, JL, YZ); Department of Hepato-Biliary-Pancreatic Surgery, University of Tokyo Hospital, University of Tokyo, Tokyo, Japan (WT); Department of Hepato-Biliary-Pancreatic Surgery, London Health Sciences Centre, Western University, London, Canada (RHA, KAB)
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95
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Zhou Y, Lei X, Wu L, Wu X, Xu D, Li B. Outcomes of hepatectomy for noncirrhotic hepatocellular carcinoma: A systematic review. Surg Oncol 2014; 23:236-42. [DOI: 10.1016/j.suronc.2014.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 10/22/2014] [Accepted: 11/02/2014] [Indexed: 12/11/2022]
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96
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Ashes C, Slinger P. Volume Management and Resuscitation in Thoracic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2014. [DOI: 10.1007/s40140-014-0081-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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97
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Guo JY, Li DW, Liao R, Huang P, Kong XB, Wang JM, Wang HL, Luo SQ, Yan X, Du CY. Outcomes of simple saline-coupled bipolar electrocautery for hepatic resection. World J Gastroenterol 2014; 20:8638-8645. [PMID: 25024620 PMCID: PMC4093715 DOI: 10.3748/wjg.v20.i26.8638] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 02/14/2014] [Accepted: 04/03/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the application of bipolar coagulation (BIP) in hepatectomy by comparing the efficacy of BIP alone, cavitron ultrasonic surgical aspirator (CUSA) + BIP and conventional clamp crushing (CLAMP).
METHODS: Based on our database of patient records, a total of 380 consecutive patients who underwent hepatectomy at our hospital were retrospectively studied for the efficacy of BIP alone, CUSA + BIP and CLAMP. Of all the patients, 75 received saline-coupled BIP (Group A), 53 received CUSA + BIP (Group B), and 252 received CLAMP (Group C). The pre-, mid-, and postoperative clinical manifestations were compared, and the effects of those maneuvers were evaluated.
RESULTS: There was no obvious difference among the preoperative indexes between the different groups. The operative time was longer in Groups A and B than in Group C (P < 0.001 for both). The amount of bleeding and the rate of transfusion during the operation were significantly higher in Group C than in Groups A and B (P < 0.001 for all). The incidence of postoperative complications in Group C (46.43%) was higher than that in Groups A (30.67%, P = 0.015) and B (28.30%, P = 0.016). The patients’ liver function recovery and postoperative hospital stay were not significantly different. BIP could decrease intraoperative hemorrhage and postoperative complications compared to CLAMP.
CONCLUSION: Simple saline-coupled BIP should be considered a safe and reliable technique for liver resection to decrease intraoperative hemorrhage and postoperative complications.
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98
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Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surg 2014; 14:34. [PMID: 24884867 PMCID: PMC4057617 DOI: 10.1186/1471-2482-14-34] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/19/2014] [Indexed: 01/02/2023] Open
Abstract
Background It is speculated that blood transfusion may induce adverse consequences after cancer surgery due to immunosuppression. This study was intended to assess the impact of perioperative blood transfusion on the prognosis of patients who underwent lung cancer resection. Methods Eligible studies were identified through a computerized literature search. The pooled relative risk ratio (RR) with 95% confidence interval (CI) was calculated using Review Manager 5.1 Software. Results Eighteen studies with a total of 5915 participants were included for this meta-analysis. Pooled analysis showed that perioperative blood transfusion was associated with worse overall survival (RR: 1.25, 95% CI: 1.13-1.38; P <0.001) and recurrence-free survival (RR: 1.42, 95% CI: 1.20-1.67; P <0.001) in patients with resected lung cancer. Conclusions Perioperative blood transfusion appears be associated with a worse prognosis in patients undergoing lung cancer resection. These data highlight the importance of minimizing blood transfusion during surgery.
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Affiliation(s)
| | | | | | - Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, Oncologic Center of Xiamen; First affiliated Hospital of Xiamen University, Xiamen 361003, China.
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van der Schaaf M, Derogar M, Johar A, Rutegård M, Gossage J, Mason R, Lagergren P, Lagergren J. Reoperation after oesophageal cancer surgery in relation to long-term survival: a population-based cohort study. BMJ Open 2014; 4:e004648. [PMID: 24650808 PMCID: PMC3963069 DOI: 10.1136/bmjopen-2013-004648] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The influence of reoperation on long-term prognosis is unknown. In this large population-based cohort study, it was aimed to investigate the influence of a reoperation within 30 days of oesophageal cancer resection on survival even after excluding the initial postoperative period. DESIGN This was a nationwide population-based retrospective cohort study. SETTING All hospitals performing oesophageal cancer resections during the study period (1987-2010) in Sweden. PARTICIPANTS Patients operated for oesophageal cancer with curative intent in 1987-2010. PRIMARY AND SECONDARY OUTCOMES Adjusted HRs of all cause, early and late mortality up to 5 years after reoperation following oesophageal cancer resection. RESULTS Among 1822 included patients, the 200 (11%) who were reoperated had a 27% increased HR of all-cause mortality (adjusted HR 1.27, 95% CI 1.05 to 1.53) and 28% increased HR of disease-specific mortality (adjusted HR 1.28, 95% CI 1.04 to 1.59), compared to those not reoperated. Reoperation for anastomotic insufficiency in particular was followed by an increased mortality (adjusted HR 1.82, 95% CI 1.19 to 2.76). CONCLUSIONS This large and population-based nationwide cohort study shows that reoperation within 30 days after primary oesophageal resection was associated with increased mortality, even after excluding the initial 3 months after surgery. This finding stresses the need to consider any actions that might prevent complications and reoperation after oesophageal cancer resection.
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Affiliation(s)
| | - Maryam Derogar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Asif Johar
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Martin Rutegård
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - James Gossage
- Department of Surgery, St Thomas’ Hospital, London, UK
| | - Robert Mason
- Department of Surgery, St Thomas’ Hospital, London, UK
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, St Thomas’ Hospital, London, UK
- Division of Cancer Studies, King's College London, London, UK
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