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Patlán M, Sánchez-Muñoz F, Amezcua-Guerra LM, Granados A, Páez A, Massó F, Mejía AM, Soster A, Bojalil R, Pavón L, Jiménez-Zamudio LA, Márquez-Velasco R. Effect of fresh frozen plasma on the in vitro activation of U937 monocytes: a potential role for the age of blood donors and their underlying cytokine profile. Biol Res 2017; 50:42. [PMID: 29268779 PMCID: PMC5740577 DOI: 10.1186/s40659-017-0146-3] [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: 01/24/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Fresh frozen plasma (FFP) administration may increase the risk of nosocomial infections in parallel with the development of immune modulation. This could be driven by soluble mediators, possibly influencing the in vitro activation of human U937 monocyte cells, in a manner dependent on the age of the donors. METHODS FFP donors were stratified into groups of 19-30 years, 31-40 years or 41-50 years, and U937 cells were cultured with FFP (alone or plus lipopolysaccharide-LPS) for 24 h. Both in FFP and supernatants, TNF, IL-1β, IL-6, and IL-10 levels were measured by ELISA. Additionally, CD11B, TLR2, and CASP3 gene expression were measured by qtPCR in U937 cells. Total phagocytic activity was also assayed. RESULTS Elevated IL-10, but low TNF and IL-1β levels were measured in FFP from individuals aged 19-40 years, whereas in individuals aged 41-50 years FFP were characterized by equalized TNF and IL-10 levels. Elevated IL-6 levels were found in all FFP samples, especially in those from the oldest individuals. FFP stimulation was associated with striking modifications in cytokine production in an age-dependent way. Exposure to FFP attenuates the response to LPS. TLR2 and CD11B expression were enhanced regardless of the age of plasma donors, although CASP3 expression was increased only when FFP from individuals aged 19-40 years were tested. Phagocytosis decreased after exposure to FFP regardless of donor age. CONCLUSION Our results suggest that soluble mediators in FFP may modulate the functioning of monocytes. Interestingly, this effect appears to be partially influenced by the age of donors.
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Affiliation(s)
- Mariana Patlán
- Doctorado en Ciencias Quimicobiológicas, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Mexico City, Mexico.,Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico
| | - Fausto Sánchez-Muñoz
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico
| | - Luis M Amezcua-Guerra
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico.,Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Adriana Granados
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico
| | - Araceli Páez
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Felipe Massó
- Department of Physiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Ana M Mejía
- Blood Bank, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Angeles Soster
- Blood Bank, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Rafael Bojalil
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico.,Department of Health Care, Universidad Autónoma Metropolitana-Xochimilco, Mexico City, Mexico
| | - Lenin Pavón
- Neuropsicoimmunology Laboratory, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico
| | - Luis A Jiménez-Zamudio
- Department of Immunology, Escuela Nacional de Ciencias Biológicas, Instituto Politecnico Nacional, Prolongación de Carpio y Plan de Ayala s/n, Santo Tomas, 11340, Mexico City, Mexico.
| | - Ricardo Márquez-Velasco
- Department of Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano No1, Col Sección XVI, 14080, Mexico City, Mexico.
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202
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Chamaraux-Tran TN, Piegeler T. The Amide Local Anesthetic Lidocaine in Cancer Surgery-Potential Antimetastatic Effects and Preservation of Immune Cell Function? A Narrative Review. Front Med (Lausanne) 2017; 4:235. [PMID: 29326939 PMCID: PMC5742360 DOI: 10.3389/fmed.2017.00235] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/06/2017] [Indexed: 12/13/2022] Open
Abstract
Surgical removal of the primary tumor in solid cancer is an essential component of the treatment. However, the perioperative period can paradoxically lead to an increased risk of cancer recurrence. A bimodal dynamics for early-stage breast cancer recurrence suggests a tumor dormancy-based model with a mastectomy-driven acceleration of the metastatic process and a crucial role of the immunosuppressive state during the perioperative period. Recent evidence suggests that anesthesia could also influence the progress of the disease. Local anesthetics (LAs) have long been used for their properties to block nociceptive input. They also exert anti-inflammatory capacities by modulating the liberation or signal propagation of inflammatory mediators. Interestingly, LAs can reduce viability and proliferation of many cancer cells in vitro as well. Additionally, retrospective clinical trials have suggested that regional anesthesia for cancer surgery (either with or without general anesthesia) might reduce the risk of recurrence. Lidocaine, a LA, which can be administered intravenously, is widely used in clinical practice for multimodal analgesia. It is associated with a morphine-sparing effect, reduced pain scores, and in major surgery probably also with a reduced incidence of postoperative ileus and length of hospital stay. Systemic delivery might therefore be efficient to target residual disease or reach cells able to form micrometastasis. Moreover, an in vitro study has shown that lidocaine could enhance the activity of natural killer (NK) cells. Due to their ability to recognize and kill tumor cells without the requirement of prior antigen exposure, NKs are the main actor of the innate immune system. However, several perioperative factors can reduce NK activity, such as stress, pain, opioids, or general anesthetics. Intravenous lidocaine as part of the perioperative anesthesia regimen would be of major interest for clinicians, as it might bear the potential to reduce the risk of cancer recurrence or progression patients undergoing cancer surgery. As a well-known pharmaceutical agent, lidocaine might therefore be a promising candidate for oncological drug repurposing. We urgently need clinical randomized trials assessing the protective effect of lidocaine on NKs function and against recurrence after cancer surgery to achieve a “proof of concept.”
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Affiliation(s)
- Thiên-Nga Chamaraux-Tran
- Département d'Anesthésie et Réanimation Chirurgicale, Hôpital Hautepierre, CHU Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Unité Mixte de Recherche 7104, Centre National de la Recherche Scientifique, U964 Institut National de Santé et de Recherche Médicale, Université de Strasbourg, Illkirch, France
| | - Tobias Piegeler
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany
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203
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Hassani H, Khoshdel A, Sharifzadeh SR, Heydari MF, Alizadeh S, Noroozi Aghideh A. TNF-α and TGF-ß level after intraoperative allogeneic red blood cell transfusion in orthopedic operation patients. Turk J Med Sci 2017; 47:1813-1818. [PMID: 29306243 DOI: 10.3906/sag-1508-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background/aim: Blood transfusion is associated with immunosuppression, referred to as transfusion-related immunomodulation (TRIM). In this study, for the first time, changes in the concentration of TGF-ß and TNF-α were measured postoperatively in orthopedic patients with intraoperational allogeneic red blood cell transfusion. Considering the use of packed cell units with different ages, it is possible to suggest the more appropriate product for clinical applications.Materials and methods: Two groups of 35 orthopedic surgery patients (with or without transfusion as case and control groups, respectively) were involved. Serum levels of TNF-α and TGF-ß were measured by ELISA.Results: The data suggested significant differences in age (P = 0.0001), lowered hemoglobin (P = 0.003), and hematocrit (P = 0.003) between the control and case groups. Pre- and postoperation levels of TNF-α and TGF- ßwere not significantly different, but the results showed significant increases in levels of both cytokines after the operation (P = 0.0001) in both groups.Conclusion: Increased levels of TNF-α and TGF-ß are probably related to surgery and packed cell transfusion, respectively. Further studies using more packed cell units or other blood products and assessment of more cytokines are needed to have better understanding about this issue.
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204
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Ciepluch B, Wilson-Robles H, Levine G, Smith R, Wright GA, Miller T, O'Brien MT, Thieman Mankin KM. Removal of hemangiosarcoma cells from canine blood with a cell salvage system and leukocyte reduction filter. Vet Surg 2017; 47:293-301. [DOI: 10.1111/vsu.12760] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 06/22/2017] [Accepted: 06/29/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Brittany Ciepluch
- Department of Small Animal Clinical Sciences; Texas A&M University; College Station Texas
| | - Heather Wilson-Robles
- Department of Small Animal Clinical Sciences; Texas A&M University; College Station Texas
| | - Gwendolyn Levine
- Department of Veterinary Pathobiology; Texas A&M University; College Station Texas
| | - Roger Smith
- Department of Veterinary Pathobiology; Texas A&M University; College Station Texas
| | - Gus A. Wright
- Department of Veterinary Pathobiology; Texas A&M University; College Station Texas
| | - Tasha Miller
- Department of Small Animal Clinical Sciences; Texas A&M University; College Station Texas
| | - Maureen T. O'Brien
- Department of Veterinary Pathobiology; Texas A&M University; College Station Texas
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205
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Park HM, Park SJ, Shim JR, Lee EC, Lee SD, Han SS, Kim SH. Perioperative transfusion in pancreatoduodenectomy: The double-edged sword of pancreatic surgeons. Medicine (Baltimore) 2017; 96:e9019. [PMID: 29245285 PMCID: PMC5728900 DOI: 10.1097/md.0000000000009019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We designed the study to clarify the prognostic significance of perioperative (preoperative, intraoperative, and postoperative) red blood cell (RBC) transfusion following pancreaticoduodenectomy (PD) for periampullary cancers.This study retrospectively analyzed 244 periampullary cancer patients (pancreatic cancer, 124 patients; bile duct cancer, 63 patients; and ampullary cancer, 57 patients) treated by PD from June 2001 to June 2010 at the National Cancer Center, Korea (NCC2017-0106).A total of 112 (46%) of 244 patients had received transfusion (preoperative, 5%; intraoperative, 17%; and postoperative, 37%). The 5-year survival rate of patients without perioperative transfusion was 36%, whereas that of patients with a transfusion was 25% (P = .04). Perioperative transfusion and intraoperative transfusion were found to be independent poor prognostic factors [relative risk (RR): 1.52 and 1.95, respectively]. The independent factors associated with perioperative transfusion were being female, operation time >420 minutes, portal vein (PV) resection, and preoperative serum hemoglobin (Hb) < 12 mg/dL. As the amount of perioperative transfusion increased, overall survival (OS) decreased.Perioperative transfusion, especially intraoperative transfusion was an independent prognostic factor for survival after PD. Therefore, for patients with periampullary cancer, intraoperative bleeding and operation time should be minimized and preoperative anemia corrected.
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206
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Dupuis C, Sonneville R, Adrie C, Gros A, Darmon M, Bouadma L, Timsit JF. Impact of transfusion on patients with sepsis admitted in intensive care unit: a systematic review and meta-analysis. Ann Intensive Care 2017; 7:5. [PMID: 28050898 PMCID: PMC5209327 DOI: 10.1186/s13613-016-0226-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 12/15/2016] [Indexed: 01/28/2023] Open
Abstract
Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. A threshold of 7 g/dL for stabilized patients with sepsis is commonly proposed, although debated. The aim of the study was to compare the benefit and harm of restrictive versus liberal RBCT strategies in order to guide physicians on RBCT strategies in patients with severe sepsis or septic shock. Four outcomes were assessed: death, nosocomial infection (NI), acute lung injury (ALI) and acute kidney injury (AKI). Studies assessing RBCT strategies or RBCT impact on outcome and including intensive care unit (ICU) patients with sepsis were assessed. Two systematic reviews were achieved: first for the randomized controlled studies (RCTs) and second for the observational studies. MEDLINE, EMBASE, Web of Science Core Collection, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinical Trials.gov were analyzed up to March 01, 2015. Der Simonian and Laird random-effects models were used to report pooled odds ratios (ORs). Subgroup analyses and meta-regressions were performed to explore studies heterogeneity. One RCT was finally included. The restrictive RBCT strategy was not associated with harm or benefit compared to liberal strategy. Twelve cohort studies were included, of which nine focused on mortality rate. RBCT was not associated with increased mortality rate (overall pooled OR was 1.10 [0.75, 1.60]; I 2 = 57%, p = 0.03), but was associated with the occurrence of NI (2 studies: pooled OR 1.25 [1.04-1.50]; I 2 = 0%, p = 0.97), the occurrence of ALI (1 study: OR 2.75 [1.22-6.37]; p = 0.016) and the occurrence of AKI (1 study: OR 5.22 [2.1-15.8]; p = 0.001). Because there was only one RCT, the final meta-analyses were only based on the cohort studies. As a result, the safety of a RBCT restrictive strategy was confirmed, although only one study specifically focused on ICU patients with sepsis. Then, RBCT was not associated with increased mortality rate, but was associated with increased in occurrence of NI, ALI and AKI. Nevertheless, the data on RBCT in patients with sepsis are sparse and the high heterogeneity between studies prevents from drawing any definitive conclusions.
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Affiliation(s)
- Claire Dupuis
- UMR 1137 - IAME Team 5 – DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
- Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018 Paris, France
| | - Romain Sonneville
- Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018 Paris, France
| | - Christophe Adrie
- Medical-Surgical ICU, Delafontaine Hospital, 2 rue du docteur Delafontaine, BP 279, 93 205 Saint-Denis, France
| | - Antoine Gros
- Medical-Surgical ICU, Versailles Hospital, 177 Rue de Versailles, 78150 Le Chesnay, France
| | - Michael Darmon
- Medical ICU, Saint-Etienne University Hospital, Avenue Albert Raymond, 42270 Saint-Priest-en-Jarez, France
| | - Lila Bouadma
- UMR 1137 - IAME Team 5 – DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
- Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018 Paris, France
| | - Jean-François Timsit
- UMR 1137 - IAME Team 5 – DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/Univ Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France
- Medical and Infectious Intensive Care Unit, AP-HP, Hôpital Bichat Claude Bernard, Paris Diderot University, 75018 Paris, France
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207
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Yoshimatsu G, Shahbazov R, Saracino G, Lawrence MC, Kim PT, Onaca N, Beecherl EE, Naziruddin B, Levy MF. The impact of allogenic blood transfusion on the outcomes of total pancreatectomy with islet autotransplantation. Am J Surg 2017; 214:849-855. [DOI: 10.1016/j.amjsurg.2017.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 02/07/2023]
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208
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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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209
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Vetterlein MW, Gild P, Kluth LA, Seisen T, Gierth M, Fritsche HM, Burger M, Protzel C, Hakenberg OW, von Landenberg N, Roghmann F, Noldus J, Nuhn P, Pycha A, Rink M, Chun FKH, May M, Fisch M, Aziz A. Peri-operative allogeneic blood transfusion does not adversely affect oncological outcomes after radical cystectomy for urinary bladder cancer: a propensity score-weighted European multicentre study. BJU Int 2017; 121:101-110. [DOI: 10.1111/bju.14012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Malte W. Vetterlein
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Philipp Gild
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Luis A. Kluth
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Seisen
- Department of Urology; Pitié-Salpêtrière Hospital; Pierre and Marie Curie University; Paris France
| | - Michael Gierth
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Hans-Martin Fritsche
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Maximilian Burger
- Department of Urology; Caritas St. Josef Medical Centre; University of Regensburg; Regensburg Germany
| | - Chris Protzel
- Department of Urology; University Medical Centre Rostock; Rostock Germany
| | | | | | - Florian Roghmann
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Joachim Noldus
- Department of Urology; Marien Hospital Herne; Ruhr-University Bochum; Herne Germany
| | - Philipp Nuhn
- Department of Urology; Mannheim Medical Centre; University of Heidelberg; Mannheim Germany
| | - Armin Pycha
- Department of Urology; Central Hospital of Bolzano; Bolzano Italy
- Centre for Urology and Nephrology; Faculty of Medicine; Sigmund Freud University Vienna, Vienna Austria
| | - Michael Rink
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Felix K.-H. Chun
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Matthias May
- Department of Urology; St. Elisabeth Medical Centre; Straubing Germany
| | - Margit Fisch
- Department of Urology; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - Atiqullah Aziz
- Department of Urology; University Medical Centre Rostock; Rostock Germany
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Comparison of Operative Time with Conventional Fluoroscopy Versus Spinal Neuronavigation in Instrumented Spinal Tumor Surgery. World Neurosurg 2017; 105:412-419. [DOI: 10.1016/j.wneu.2017.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/27/2022]
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211
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Aquina CT, Blumberg N, Becerra AZ, Boscoe FP, Schymura MJ, Noyes K, Monson JRT, Fleming FJ. Association Among Blood Transfusion, Sepsis, and Decreased Long-term Survival After Colon Cancer Resection. Ann Surg 2017; 266:311-317. [PMID: 27631770 DOI: 10.1097/sla.0000000000001990] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate the potential additive effects of blood transfusion and sepsis on colon cancer disease-specific survival, cardiovascular disease-specific survival, and overall survival after colon cancer surgery. BACKGROUND Perioperative blood transfusions are associated with infectious complications and increased risk of cancer recurrence through systemic inflammatory effects. Furthermore, recent studies have suggested an association among sepsis, subsequent systemic inflammation, and adverse cardiovascular outcomes. However, no study has investigated the association among transfusion, sepsis, and disease-specific survival in postoperative patients. METHODS The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for stage I to III colon cancer resections from 2004 to 2011. Propensity-adjusted survival analyses assessed the association of perioperative allogeneic blood transfusion, sepsis, and 5-year colon cancer disease-specific survival, cardiovascular disease-specific survival, and overall survival. RESULTS Among 24,230 patients, 29% received a transfusion and 4% developed sepsis. After risk adjustment, transfusion and sepsis were associated with worse colon cancer disease-specific survival [(+)transfusion: hazard ratio (HR) 1.19, 95% confidence interval (CI) 1.09-1.30; (+)sepsis: HR 1.84, 95% CI 1.44-2.35; (+)transfusion/(+)sepsis: HR 2.27, 95% CI 1.87-2.76], cardiovascular disease-specific survival [(+)transfusion: HR 1.18, 95% CI 1.04-1.33; (+)sepsis: HR 1.63, 95% CI 1.14-2.31; (+)transfusion/(+)sepsis: HR 2.04, 95% CI 1.58-2.63], and overall survival [(+)transfusion: HR 1.21, 95% CI 1.14-1.29; (+)sepsis: HR 1.76, 95% CI 1.48-2.09; (+)transfusion/(+)sepsis: HR 2.36, 95% CI 2.07-2.68] relative to (-)transfusion/(-)sepsis. Additional analyses suggested an additive effect with those who both received a blood transfusion and developed sepsis having even worse survival. CONCLUSIONS Perioperative blood transfusions are associated with shorter survival, independent of sepsis, after colon cancer resection. However, receiving a transfusion and developing sepsis has an additive effect and is associated with even worse survival. Restrictive perioperative transfusion practices are a possible strategy to reduce sepsis rates and improve survival after colon cancer surgery.
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Affiliation(s)
- Christopher T Aquina
- *Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY †Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY ‡New York State Cancer Registry, New York State Department of Health, Albany, NY §Center for Colon and Rectal Surgery, Florida Hospital Medical Group, University of Central Florida College of Medicine, Orlando, FL
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Spadaro S, Taccone FS, Fogagnolo A, Fontana V, Ragazzi R, Verri M, Valpiani G, Greco P, Bianconi M, Govoni M, Reverberi R, Volta CA. The effects of storage of red blood cells on the development of postoperative infections after noncardiac surgery. Transfusion 2017; 57:2727-2737. [PMID: 28782123 DOI: 10.1111/trf.14249] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/12/2017] [Accepted: 06/09/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prolonged storage of red blood cells (RBCs) is a potential risk factor for postoperative infections. The objective of this study was to examine the effect of age of RBCs transfused on development of postoperative infection. STUDY DESIGN AND METHODS In this prospective, double-blind randomized trial, 199 patients undergoing elective noncardiac surgery and requiring RBC transfusion were assigned to receive nonleukoreduced RBCs stored for not more than 14 days ("fresh blood" group, n = 101) or for more than 14 days ("old blood" group, n = 98). The primary outcome was occurrence of infection within 28 days after surgery; secondary outcomes were postoperative acute kidney injury (AKI), in-hospital and 90-day mortality, admission to intensive care unit, and hospital length of stay (LOS). As older blood was not always available, an "as-treated" (AT) analysis was also performed according to actual age of the RBCs transfused. RESULTS The median [interquartile range] storage time of RBCs was 6 [5-10] and 15 [11-20] days in fresh blood and in old blood groups, respectively. The occurrence of postoperative infection did not differ between groups (fresh blood 22% vs. old blood 25%; relative risk [RR], 1.17; confidence interval [CI], 0.71-1.93), although wound infections occurred more frequently in old blood (15% vs. 5%; RR, 3.09; CI, 1.17- 8.18). Patients receiving older units had a higher rate of AKI (24% vs. 6%; p < 0.001) and, according to AT analysis, longer LOS (mean difference, 3.6 days; CI, 0.6-7.5). CONCLUSION Prolonged RBC storage time did not increase the risk of postoperative infection. However, old blood transfusion increased wound infections rate and incidence of AKI.
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Affiliation(s)
- Savino Spadaro
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Fabio Silvio Taccone
- Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Alberto Fogagnolo
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Vito Fontana
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Riccardo Ragazzi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Marco Verri
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Giorgia Valpiani
- Statistics Unit, Research and Innovation Office, Arcispedale Sant'Anna
| | - Pantaleo Greco
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Margherita Bianconi
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
| | - Maurizio Govoni
- Blood Transfusion Service, Sant'Anna Hospital, Ferrara, Italy
| | | | - Carlo Alberto Volta
- Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Unità Operativa di Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria Sant'Anna, Università di Ferrara, Ferrara, Italy
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Xu Q, Shi NJ, Zhang H, Zhu YM. Effects of combined general-epidural anesthesia and total intravenous anesthesia on cellular immunity and prognosis in patients with non‑small cell lung cancer: A comparative study. Mol Med Rep 2017; 16:4445-4454. [PMID: 28765974 PMCID: PMC5647004 DOI: 10.3892/mmr.2017.7144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/04/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the present study was to investigate the effects of combined general-epidural anesthesia (CGEA) and total intravenous anesthesia (TIVA) on cellular immunity and prognosis in patients with non-small cell lung cancer (NSCLC) in a Chinese population. One-hundred and twenty NSCLC patients were randomly divided into a TIVA group (n=60) and a CGEA group (n=60) using a random number table. All patients underwent video-assisted thoracoscopic surgery for radical resection. Blood pressure (BP) and peripheral oxygen saturation (SpO2) were measured. Post-operative analgesic effects were evaluated with a visual analog scale pain score. Flow cytometry was applied to measure T lymphocyte subsets [cluster of differentiation (CD)3+, CD4+, CD8+ and CD4+/CD8+] and natural killer cell CD56+. A 3-year follow-up was conducted to observe the prognosis. The analgesic effects of CGEA were identified to be better than those of TIVA. Compared with the TIVA group, the CGEA group demonstrated a shorter time of spontaneous breathing recovery, eyes opening, and extubation, lower heart rate, blood pressure and mean arterial pressure, and higher SpO2. At 24 and 48 h after surgery, CD3+, CD4+, CD4+/CD8+ and CD56+ in the CGEA group were higher than those in the TIVA group. At 72 h after surgery, CD3+, CD4+, CD4+/CD8+ in the CGEA group were higher than those in the TIVA group. These results indicate that CGEA and TIVA effected cellular immunity, and CGEA had a reduced effect on cellular immunity and improved postoperative analgesic effects.
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Affiliation(s)
- Qiang Xu
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Nian-Jun Shi
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Hao Zhang
- Department of Anesthesiology, Linyi People's Hospital, Linyi, Shandong 276003, P.R. China
| | - Yan-Mei Zhu
- Department of Orthopedics, Chinese Medicine Hospital in Linyi, Linyi, Shandong 276003, P.R. China
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214
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Cybulska P, Goss C, Tew WP, Parameswaran R, Sonoda Y. Indications for and complications of transfusion and the management of gynecologic malignancies. Gynecol Oncol 2017; 146:416-426. [PMID: 28528916 PMCID: PMC5527999 DOI: 10.1016/j.ygyno.2017.05.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 02/06/2023]
Abstract
Anemia, which is highly prevalent in oncology patients, is one of the most established negative prognostic factors for several gynecologic malignancies. Multiple factors can cause or contribute to the development of anemia in patients with gynecologic cancers; these factors include blood loss (during surgery or directly from the tumor), renal impairment (caused by platinum-based chemotherapy), and marrow dysfunction (from metastases, chemotherapy, and/or radiation therapy). Several peri- and intra-operative strategies can be used to optimize patient management and minimize blood loss related to surgery. Blood transfusions are routinely employed as corrective measures against anemia; however, blood transfusions are one of the most overused healthcare interventions. There are safe and effective evidence-based blood transfusion strategies used in other patient populations that warrant further investigation in the surgical oncology setting. Blood is a valuable healthcare resource, and clinicians can learn to use it more judiciously through knowledge of the potential risks and complications of blood interventions, as well as the ability to properly identify the patients most likely to benefit from such interventions.
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Affiliation(s)
- Paulina Cybulska
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cheryl Goss
- Hematology and Coagulation Laboratory Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - William P Tew
- Gynecologic Medical Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Rekha Parameswaran
- Transfusion Medicine Service, Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Hematology Service, Department of Medicine, Division of Hematologic Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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215
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Kormi SMA, Seghatchian J. Taming the immune system through transfusion in oncology patients. Transfus Apher Sci 2017; 56:310-316. [PMID: 28651910 DOI: 10.1016/j.transci.2017.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Blood transfusion is a clinical replacement therapy with many successes with some benefit and, also, some harm. Cancer is a multifaceted disease potentially associated with the immune system's weakness where the cancerous tumor cells escape from the immune system. Allogeneic blood transfusion, through five major mechanisms including the lymphocyte-T set, myeloid-derived suppressor cells (MDSCs), tumor-associated macrophages (TAMs), natural killer cells (NKCs), and dendritic cells (DCs) can help the recipient's defense mechanisms. On the other hand, the role for each of the listed items includes activation of the antitumor CD8+ cytotoxic T lymphocytes (CD8+/CTL), temporal inactivation of Tregs, inactivation of the STAT3 signaling pathway, the use of bacteria to enhance the antitumor immune response and cellular immunotherapy. The above issues are concisely addressed in this manuscript based on a literature survey on this topic carried out by the first author.
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Affiliation(s)
- Seyed Mohammad Amin Kormi
- Cancer Genetics Research Unit, Reza Radiation Oncology Center, Mashhad, Iran; Department of Biology, Faculty of Science, University of Zabol, Zabol, Iran.
| | - Jerard Seghatchian
- International Consultancy in Blood Components Quality/ Safety Improvement, Audit/ Inspection and DDR Strategies, London, United Kingdom.
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216
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Frazier SK, Higgins J, Bugajski A, Jones AR, Brown MR. Adverse Reactions to Transfusion of Blood Products and Best Practices for Prevention. Crit Care Nurs Clin North Am 2017; 29:271-290. [PMID: 28778288 DOI: 10.1016/j.cnc.2017.04.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transfusion, a common practice in critical care, is not without complication. Acute adverse reactions to transfusion occur within 24 hours and include acute hemolytic transfusion reaction, febrile nonhemolytic transfusion reaction, allergic and anaphylactic reactions, and transfusion-related acute lung injury, transfusion-related infection or sepsis, and transfusion-associated circulatory overload. Delayed transfusion adverse reactions develop 48 hours or more after transfusion and include erythrocyte and platelet alloimmunization, delayed hemolytic transfusion reactions, posttransfusion purpura, transfusion-related immunomodulation, transfusion-associated graft versus host disease, and, with long-term transfusion, iron overload. Clinical strategies may reduce the likelihood of reactions and improve patient outcomes.
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Affiliation(s)
- Susan K Frazier
- PhD Program, RICH Heart Program, College of Nursing, University of Kentucky, CON Building, Office 523, 751 Rose Street, Lexington, KY 40536-0232, USA.
| | - Jacob Higgins
- College of Nursing, University of Kentucky, CON Building, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Andrew Bugajski
- College of Nursing, University of Kentucky, CON Building, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Allison R Jones
- Department of Acute, Chronic & Continuing Care, School of Nursing, University of Alabama at Birmingham, NB 543, 1720 2nd Avenue South, Birmingham, AL 35294-1210, USA
| | - Michelle R Brown
- Clinical Laboratory Science, University of Alabama at Birmingham, SHPB 474, 1705 University Boulevard, Birmingham, AL 35294, USA
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217
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Balance Between the Proinflammatory and Anti-Inflammatory Immune Responses with Blood Transfusion in Sepsis. Crit Care Nurs Clin North Am 2017; 29:331-340. [PMID: 28778292 DOI: 10.1016/j.cnc.2017.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Blood product transfusion may exacerbate the initial immunosuppressive response of sepsis. Nurses and other patient care providers must be diligent in recognizing and managing a worsening immune status, using flow cytometry to monitor patients' immune status. This type of monitoring may be instrumental in reducing morbidity and mortality in persons with sepsis. This article discusses the recent literature on the associated inflammatory responses that occur with blood transfusion and provides an analysis of alterations in key inflammatory pathways in response to transfusion in a sepsis population.
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218
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Do packed red blood cell transfusions really worsen oncologic outcomes in colon cancer? Surgery 2017; 162:586-591. [PMID: 28606725 DOI: 10.1016/j.surg.2017.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/14/2017] [Accepted: 03/29/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Data from small retrospective studies have argued that perioperative packed red blood cell transfusions may increase the risk of developing metastatic recurrence in cancer patients. This study tests this assumption in a large cohort spanning a decade of operatively treated colon cancer patients. METHODS All patients undergoing primary resection of a colon cancer at a tertiary care center between 2004-2014 (n = 1,423) were included in a retrospective review of a prospectively maintained data repository. Survival and disease-free survival were compared and also adjusted in multivariable Cox regression standardized for follow-up, American Society of Anesthesiologists score, age, sex, postoperative chemotherapy, baseline staging, and tumor grade. RESULTS Of the 1,423 patients, 305 (21.4%) received a perioperative packed red blood cell transfusion during their index admission. During follow-up, overall mortality was greater in patients who received perioperative packed red blood cell (53.1% vs 30.9%; P < .001); however, there were no appreciable differences in rates of long-term distant recurrence (in patients without baseline metastasis 11.1% vs 13.9%; P = .25), or disease-specific mortality (21.3% vs 17.3%; P = .104; without baseline metastasis: 8.6% vs 8.9%; P = .89). Similarly, multivariable Cox regression showed no statistical difference in recurrence (hazard ratio: 0.83, 95% confidence interval, 0.83-1.26; P = .38) or disease-specific mortality (hazard ratio: 1.12, 95% confidence interval, 0.83-1.51; P = .47). CONCLUSION Mortality rates were significantly greater in patients with perioperative packed red blood cell transfusions, a finding that is backed by a body of evidence that associates perioperative packed red blood cell transfusion with comorbidity and serious illness, but contrary to earlier evidence, findings in our cohort do not support a hypothesis that perioperative perioperative packed red blood cell transfusions have a detrimental effect on recurrence rates of operatively treated colon cancer patients.
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219
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Lan N, Stocchi L, Li Y, Shen B. Perioperative blood transfusion is associated with post-operative infectious complications in patients with Crohn's disease. Gastroenterol Rep (Oxf) 2017; 6:114-121. [PMID: 29780599 PMCID: PMC5952943 DOI: 10.1093/gastro/gox023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/20/2017] [Accepted: 03/15/2017] [Indexed: 02/06/2023] Open
Abstract
Background We have previously demonstrated that blood transfusion (BT) was associated with post-operative
complications in patients undergoing surgery for Crohn’s disease (CD), based on our institutional data registry. The aim of this study was to verify the association between perioperative BT and infectious complications in CD patients enrolled in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database. Methods All CD patients undergoing surgery between 2005 and 2013 were identified from NSQIP. Variables were defined
according to the ACS NSQIP guidelines. The primary outcome was infectious complications, including superficial, deep and organ/space surgical site infection, wound dehiscence, urinary tract infection, pneumonia, systemic sepsis and septic shock. Multivariate analyses were performed to assess the risk factors for post-operative infections. Results All 10 100 eligible patients were included and 611 (6.0%) received perioperative BT. BT patients were older, lighter in weight and more likely to be functionally dependent. BT patients were more likely to have post-operative infectious
complications than those without BT, including superficial surgical site infection (SSI) (10.8% vs 7.4%, p=0.002), deep SSI (3.3% vs 1.6%, p=0.003), organ/space SSI (14.2% vs 5.4%, p<0.001), pneumonia (3.8% vs 1.3%, p<0.001), urinary tract infection (3.9% vs 2.2%, p=0.006), sepsis (11.5% vs 4.5%, p<0.001) and sepsis shock (3.1% vs 0.8%, p<0.001). Multivariate analysis showed that intra- and/or post-operative BT was an independent risk factor for post-operative infectious complications (odds ratio [OR] = 2.2; 95% confidence interval [CI]: 1.8–2.7; p<0.001) and the risk increased with each administered unit of red blood cell (OR = 1.3, 95% CI: 1.2–1.5). Other independent factors were history of smoking, chronic heart disease, diabetes, hypertension and the use of corticosteroids. Pre-operative BT, however, was not found to be a risk factor to post-operative infections. Conclusions Intra- and/or post-operative, not pre-operative, BT was found to be associated with an increased risk for post-operative infectious complications in this CD cohort. Therefore, the timing and risks and benefits of BT should be carefully balanced.
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Affiliation(s)
- Nan Lan
- Center for Inflammatory Bowel Disease, and Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Luca Stocchi
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Yi Li
- Department of Colorectal Surgery, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Bo Shen
- Center for Inflammatory Bowel Disease, and Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, Cleveland, OH, USA
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220
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Tzounakas VL, Seghatchian J, Grouzi E, Kokoris S, Antonelou MH. Red blood cell transfusion in surgical cancer patients: Targets, risks, mechanistic understanding and further therapeutic opportunities. Transfus Apher Sci 2017. [PMID: 28625825 DOI: 10.1016/j.transci.2017.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Anemia is present in more than half of cancer patients and appears to be an independent prognostic factor of short- and long-term adverse outcomes. It increases in the advanced period of cancer and perioperatively, in patients with solid tumors who undergo surgery. As a result, allogeneic red blood cell (RBC) transfusion is an indispensable treatment in cancer. However, its safety remains controversial, based on several laboratory and clinical data reporting a linkage with increased risk for cancer recurrence, infection and cancer-related mortality. Immunological, inflammatory and thrombotic reactions mediated by the residual leukocytes and platelets, the stored RBCs per se, the biological response modifiers and the plasticizer of the unit may underlie infection and tumor-promoting effects. Although the causality between transfusion and infection has been established, the effects of transfusion on cancer recurrence remain confusing; this is mainly due to the extreme biological heterogeneity that characterizes RBC donations and cancer context. In fact, the functional interplay between donation-associated factors and recipient characteristics, including tumor biology per se, inflammation, infection, coagulation and immune activation state and competence may synergistically and individually define the clinical impact of each transfusion in any given cancer patient. Our understanding of how the potential risk is mediated is important to make RBC transfusion safer and to pave the way for novel, promising and highly personalized strategies for the treatment of anemia in surgical cancer patients.
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Affiliation(s)
- Vassilis L Tzounakas
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Jerard Seghatchian
- International Consultancy in Blood Component Quality/Safety Improvement, Audit/Inspection and DDR Strategy, London, UK.
| | - Elissavet Grouzi
- Department of Transfusion Service and Clinical Hemostasis, "Saint Savvas" Oncology Hospital, Athens, Greece
| | - Styliani Kokoris
- Department of Blood Transfusion, Medical School, "Attikon" General Hospital, NKUA, Athens, Greece
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece.
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221
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Pereira NDC, Turrini RNT, Poveda VDB. Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries. Rev Esc Enferm USP 2017; 51:e03228. [PMID: 28562746 DOI: 10.1590/s1980-220x2016036203228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 02/03/2017] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To identify the length of perioperative fasting among patients submitted to gastrointestinal cancer surgeries. METHOD Retrospective cohort study, developed by consulting the medical records of 128 patients submitted to gastrointestinal cancer surgeries. RESULTS The mean of total length of fasting was 107.6 hours. The total length of fasting was significantly associated with the number of symptoms presented before (p=0.000) and after the surgery (p=0.007), the length of hospital stay (p=0.000), blood transfusion (p=0.013), nasogastric tube (p=0.001) and nasojejunal tube (p=0,003), postoperative admission at ICU (p=0.002), postoperative death (p=0.000) and length of preoperative fasting (p=0.000). CONCLUSION The length of fasting is associated with complications that affect the quality of the patients' postoperative recovery and nurses' work. The nursing team should be alert to this aspect and being responsible for overseeing the patients' interest, should not permit the unnecessary extension of fasting. OBJETIVO Identificar la duración del ayuno perioperatorio entre los pacientes sometidos a cirugías de cáncer gastrointestinal. MÉTODO Estudio de cohorte retrospectivo, por consulta de los registros médicos de 128 pacientes sometidos a cirugías de cáncer gastrointestinal. RESULTADOS La media de la duración total del ayuno fue de 107,6 horas. La duración total del ayuno se asoció significativamente con el número de síntomas presentados antes (p=0,000) y después de la cirugía (p=0,007), la duración de la estancia hospitalaria (p=0,000), transfusión de sangre (p=0,013),tubo nasogástrico (P=0,003), ingreso postoperatorio en la UCI (p=0,002), muerte postoperatoria (p=0,000) y duración del ayuno preoperatorio (p=0,000). CONCLUSIÓN La duración del ayuno se asocia con complicaciones que afectan la calidad de la recuperación postoperatoria de los pacientes y el trabajo de enfermería. El equipo de enfermería debe estar alerta en relación a este aspecto y ser responsable de supervisar el interés de los pacientes, no permitiendo la extensión innecesaria del ayuno.
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Affiliation(s)
| | - Ruth Natalia Teresa Turrini
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil
| | - Vanessa de Brito Poveda
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Médico-Cirúrgica, São Paulo, SP, Brazil
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Prognostic Significance of Blood Transfusion in Newly Diagnosed Multiple Myeloma Patients without Autologous Hematopoietic Stem Cell Transplantation. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5462087. [PMID: 28567420 PMCID: PMC5439061 DOI: 10.1155/2017/5462087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/16/2017] [Accepted: 04/04/2017] [Indexed: 02/07/2023]
Abstract
The aim of this study was to evaluate whether blood transfusions affect overall survival (OS) and progression-free survival (PFS) in newly diagnosed multiple myeloma (MM) patients without hematopoietic stem cell transplantation. A total of 181 patients were enrolled and divided into two groups: 68 patients in the transfused group and 113 patients in the nontransfused group. Statistical analyses showed that there were significant differences in ECOG scoring, Ig isotype, platelet (Plt) counts, hemoglobin (Hb) level, serum creatinine (Scr) level, and β2-microglobulin (β2-MG) level between the two groups. Univariate analyses showed that higher International Staging System staging, Plt counts < 100 × 109/L, Scr level ≥ 177 μmol/L, serum β2-MG ≥ 5.5 μmol/L, serum calcium (Ca) ≥ 2.75 mmol/L, and thalidomide use were associated with both OS and PFS in MM patients. Age ≥ 60 was associated with OS and Ig isotype was associated with PFS in MM patients. Moreover, blood transfusion was associated with PFS but not OS in MM patients. Multivariate analyses showed that blood transfusion was not an independent factor for PFS in MM patients. Our preliminary results suggested that newly diagnosed MM patients may benefit from a liberal blood transfusion strategy, since blood transfusion is not an independent impact factor for survival.
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223
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Poveda V, Nascimento A. The effect of intraoperative hypothermia upon blood transfusion needs and length of stay among gastrointestinal system cancer surgery. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2017] [Indexed: 01/17/2023]
Affiliation(s)
- V.B. Poveda
- Department of Medical and Surgical Nursing; School of Nursing; University of São Paulo; Sâo Paulo SP Brazil
| | - A.S. Nascimento
- Department of Medical and Surgical Nursing; School of Nursing; University of São Paulo; Sâo Paulo SP Brazil
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224
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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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226
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Introduction of thromboelastometry-guided administration of fresh-frozen plasma is associated with decreased allogeneic blood transfusions and post-operative blood loss in cardiopulmonary-bypass surgery. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:244-252. [PMID: 28488956 DOI: 10.2450/2017.0265-16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 01/11/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Cardiac surgery is frequently associated with excessive blood loss requiring multiple blood transfusions which are, in turn, associated with increased morbidity and mortality. We evaluated the effectiveness of rotational thromboelastometry (ROTEM®)-guided administration of fresh-frozen plasma (FFP) with regards to blood loss, transfusion requirements, and major post-operative complications. MATERIALS AND METHODS Coagulation management in 68 prospective patients undergoing cardiac surgery with cardiopulmonary bypass was based on a treatment algorithm guided by ROTEM® measurements. The primary end-point was blood loss at 24 hours after surgery. Secondary end-points were: (i) need for allogeneic blood products after cardiopulmonary bypass and 24 hours post-operatively, and (ii) post-operative complications until discharge. The results were compared with those of a retrospective, control group of 69 patients who received empirical coagulation management before implementation of the ROTEM®-guided algorithm. RESULTS Although patients with significantly lower haemoglobin levels received less packed red blood cells (PRBC) (840 vs 1,120 mL; p=0.031) and FFP (480 vs 720 mL; p=0.007) after introduction of the ROTEM® algorithm, the intra-operative blood loss and post-operative haemoglobin levels were similar in the ROTEM® and the retrospective control groups. In addition to significantly reduced blood loss and decreased requirements for PRBC (30.8 vs 62.3%; p<0.001) and FFP (25.0 vs 56.5%; p<0.001), the amounts of PRBC (315 vs 840 mL; p<0.001) and FFP (480 vs 840 mL; p=0.001) received during the first 24 hours after surgery were significantly reduced in the ROTEM® group, as was the duration of post-operative hospitalisation. DISCUSSION Compared with empirical treatment, timely ROTEM®-guided FFP administration during cardiac surgery can reduce not only overall blood product use and blood loss but also the duration of hospitalisation.
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227
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Buchner A, Grimm T, Schneevoigt BS, Wittmann G, Kretschmer A, Jokisch F, Grabbert M, Apfelbeck M, Schulz G, Gratzke C, Stief CG, Karl A. Dramatic impact of blood transfusion on cancer-specific survival after radical cystectomy irrespective of tumor stage. Scand J Urol 2017; 51:130-136. [DOI: 10.1080/21681805.2017.1295399] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Alexander Buchner
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tobias Grimm
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Georg Wittmann
- Department of Transfusion Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Friedrich Jokisch
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Markus Grabbert
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Apfelbeck
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gerald Schulz
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian Gratzke
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christian G. Stief
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alexander Karl
- Department of Urology, Ludwig-Maximilians-Universität München, Munich, Germany
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228
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Margonis GA, Sasaki K, Andreatos N, Nishioka Y, Sugawara T, Amini N, Buettner S, Hashimoto M, Shindoh J, Pawlik TM. Prognostic impact of complications after resection of early stage hepatocellular carcinoma. J Surg Oncol 2017; 115:791-804. [DOI: 10.1002/jso.24576] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 01/11/2017] [Accepted: 01/13/2017] [Indexed: 12/18/2022]
Affiliation(s)
| | - Kazunari Sasaki
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Nikolaos Andreatos
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Yujiro Nishioka
- Hepatobiliary Surgery Division; Department of Digestive Surgery; Toranomon Hospital; Tokyo Japan
| | - Toshitaka Sugawara
- Hepatobiliary Surgery Division; Department of Digestive Surgery; Toranomon Hospital; Tokyo Japan
| | - Neda Amini
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Stefan Buettner
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Masaji Hashimoto
- Hepatobiliary Surgery Division; Department of Digestive Surgery; Toranomon Hospital; Tokyo Japan
| | - Junichi Shindoh
- Hepatobiliary Surgery Division; Department of Digestive Surgery; Toranomon Hospital; Tokyo Japan
| | - Timothy M. Pawlik
- Department of Surgery; The Johns Hopkins University School of Medicine; Baltimore Maryland
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229
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Li SL, Ye Y, Yuan XH. Association between Allogeneic or Autologous Blood Transfusion and Survival in Patients after Radical Prostatectomy: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0171081. [PMID: 28135341 PMCID: PMC5279775 DOI: 10.1371/journal.pone.0171081] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/16/2017] [Indexed: 01/11/2023] Open
Abstract
Background A number of studies have investigated the effect of perioperative blood transfusion (PBT) for patients after radical prostatectomy (RP), with some reporting conflicting results. A systematic review of the literature and a meta-analysis were conducted to explore the association between PBT (autologous or allogeneic) and biochemical recurrence-free survival (BRFS), overall survival (OS) and cancer-specific survival (CSS) in patients undergoing RP. Methods The PubMed, Medline, Cochrane Library, and Embase databases were searched for published controlled clinical studies on perioperative allogeneic or autologous blood transfusion (BT) and patient survival after RP. STATA software version 12.0 was used for data analysis. We used hazard ratios (HRs) and 95% confidence intervals (CIs) to test the correlation between BT and patient survival after RP. Results Data from a total of 26,698 patients in ten published studies were included in the meta-analysis. The meta-analysis results showed that autologous BT was not associated with BRFS (HR: 1.06; 95% CI: 0.96–1.18; Z = 1.17; P = 0.24), OS (HR: 0.86; 95% CI: 0.71–1.04; Z = 1.58; P = 0.11), or CSS (HR: 0.98; 95% CI: 0.49–1.96; Z = 0.05; P = 0.96). Allogeneic BT exhibited a significant association with worse BRFS (HR: 1.09; 95% CI: 1.01–1.16; Z = 2.37; P = 0.02), OS (HR: 1.43; 95% CI: 1.24–1.64; Z = 4.95; P<0.01) and CSS (HR: 1.74; 95% CI: 1.18–2.56; Z = 2.81; P = 0.005). Conclusion Our data showed an association between allogeneic BT and reduced BRFS, OS and CSS in patients after RP. These findings indicate that perioperative blood conservation strategies are important for decreasing the allogeneic BT rate.
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Affiliation(s)
- Su-Liang Li
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
| | - Yun Ye
- Department of Laboratory Medicine, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
- * E-mail:
| | - Xiao-Hua Yuan
- Department of Blood Transfusion, The First Affiliated Hospital of Xi’an Medical University, Xi’an, Shaanxi, China
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230
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Keeler BD, Simpson JA, Ng O, Padmanabhan H, Brookes MJ, Acheson AG. Randomized clinical trial of preoperative oral versus intravenous iron in anaemic patients with colorectal cancer. Br J Surg 2017; 104:214-221. [PMID: 28092401 DOI: 10.1002/bjs.10328] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 06/01/2016] [Accepted: 08/24/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment of preoperative anaemia is recommended as part of patient blood management, aiming to minimize perioperative allogeneic red blood cell transfusion. No clear evidence exists outlining which treatment modality should be used in patients with colorectal cancer. The study aimed to compare the efficacy of preoperative intravenous and oral iron in reducing blood transfusion use in anaemic patients undergoing elective colorectal cancer surgery. METHODS Anaemic patients with non-metastatic colorectal adenocarcinoma were recruited at least 2 weeks before surgery and randomized to receive oral (ferrous sulphate) or intravenous (ferric carboxymaltose) iron. Perioperative changes in haemoglobin, ferritin, transferrin saturation and blood transfusion use were recorded until postoperative outpatient review. RESULTS Some 116 patients were included in the study. There was no difference in blood transfusion use from recruitment to trial completion in terms of either volume of blood administered (P = 0·841) or number of patients transfused (P = 0·470). Despite this, increases in haemoglobin after treatment were higher with intravenous iron (median 1·55 (i.q.r. 0·93-2·58) versus 0·50 (-0·13 to 1·33) g/dl; P < 0·001), which was associated with fewer anaemic patients at the time of surgery (75 versus 90 per cent; P = 0·048). Haemoglobin levels were thus higher at surgery after treatment with intravenous than with oral iron (mean 11·9 (95 per cent c.i. 11·5 to 12·3) versus 11·0 (10·6 to 11·4) g/dl respectively; P = 0·002), as were ferritin (P < 0·001) and transferrin saturation (P < 0·001) levels. CONCLUSION Intravenous iron did not reduce the blood transfusion requirement but was more effective than oral iron at treating preoperative anaemia and iron deficiency in patients undergoing colorectal cancer surgery.
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Affiliation(s)
- B D Keeler
- National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J A Simpson
- National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - O Ng
- National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - H Padmanabhan
- School of Cancer Sciences, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - M J Brookes
- School of Cancer Sciences, University of Birmingham, Birmingham, UK.,Department of Gastroenterology, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A G Acheson
- National Institute for Health Research Biomedical Research Unit in Gastrointestinal and Liver Diseases at Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.,Department of Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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231
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Kim SH, Kim SH, Yoon HS, Kim HK, Kim KS. Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery. Yonsei Med J 2017; 58:195-205. [PMID: 27873514 PMCID: PMC5122638 DOI: 10.3349/ymj.2017.58.1.195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/10/2016] [Accepted: 07/18/2016] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Adequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery. MATERIALS AND METHODS Ten pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes. RESULTS There was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74-6.43) vs. 3.41 g (2.46-4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82-6.07) vs. 3.60 g (2.03-6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67-10.61) vs. 6.93 g (3.09-9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50-8.78) vs. 3.70 g (2.32-5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)]. CONCLUSION SurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.
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Affiliation(s)
- Sung Hyun Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Sung Yoon
- Department of Quality Assurance, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Hyun Kyoon Kim
- Department of Research and Development, Medical Device Program, Samyang Biopharmaceuticals Corporation, Daejeon, Korea
| | - Kyung Sik Kim
- Department of Hepatobiliary and Pancreatic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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232
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Soria F, de Martino M, Leitner CV, Moschini M, Shariat SF, Klatte T. Perioperative Allogenic Blood Transfusion in Renal Cell Carcinoma: Risk Factors and Effect on Long-term Outcomes. Clin Genitourin Cancer 2016; 15:e421-e427. [PMID: 28089722 DOI: 10.1016/j.clgc.2016.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/29/2016] [Accepted: 12/03/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND We sought to create a preoperative model to predict the risk of perioperative blood transfusion (PBT) in patients with renal cell carcinoma (RCC) undergoing nephrectomy and to evaluate the effect of PBT on long-term outcomes. PATIENTS AND METHODS The present retrospective study included 648 consecutive patients who had undergone radical or partial nephrectomy for RCC at a single institution. The risk factors for PBT were analyzed using logistic regression analysis. Cox proportional hazards models addressed the effect of PBT on overall and RCC-specific mortality. RESULTS A total of 62 patients (10%) received a median of 2 red blood cell units (interquartile range, 2-3; range 1-20). On multivariable logistic regression analysis, 2 preoperative factors were independently associated with receipt of PBT: preoperative anemia (odds ratio, 6.28; P < .001) and open surgery (odds ratio, 3.40; P < .001). The risk of receiving PBT was high with both risk factors present (34%), intermediate with 1 risk factor present (7%-12%), and low with 0 risk factors present (2%). Within a median follow-up period of 63 months (interquartile range, 32-91), 108 patients (17%) had died of RCC and 177 (27%) had died of any cause. In the multivariable Cox models, PBT remained independently associated with overall mortality (hazard ratio [HR], 1.86; P = .004) and RCC-specific mortality (HR, 1.79; P = .007). A dose-dependent association of PBT with RCC-specific mortality was observed (HR, 1.14; P = .01). CONCLUSION In patients undergoing surgery for RCC, PBT was associated with adverse overall and RCC-specific mortality. Patients with preoperative anemia and those scheduled to undergo open surgery are at an increased risk of PBT and could be candidates for perioperative optimization techniques.
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Affiliation(s)
- Francesco Soria
- Department of Urology, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | | | - Carmen V Leitner
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Urological Research Institute, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Weill Cornell Medical College, New York, NY
| | - Tobias Klatte
- Department of Urology, Medical University of Vienna, Vienna, Austria.
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233
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Almizraq RJ, Seghatchian J, Acker JP. Extracellular vesicles in transfusion-related immunomodulation and the role of blood component manufacturing. Transfus Apher Sci 2016; 55:281-291. [DOI: 10.1016/j.transci.2016.10.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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234
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Paulino Pereira NR, Langerhuizen DW, Janssen SJ, Hornicek FJ, Ferrone ML, Harris MB, Schwab JH. Are perioperative allogeneic blood transfusions associated with 90-days infection after operative treatment for bone metastases? J Surg Oncol 2016; 114:997-1003. [DOI: 10.1002/jso.24440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/05/2016] [Indexed: 01/04/2023]
Affiliation(s)
- Nuno Rui Paulino Pereira
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - David W.G. Langerhuizen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Stein J. Janssen
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Francis J. Hornicek
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
| | - Marco L. Ferrone
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Brigham and Women's Hospital-Harvard Medical School; Boston Massachusetts
| | - Mitchel B. Harris
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Brigham and Women's Hospital-Harvard Medical School; Boston Massachusetts
| | - Joseph H. Schwab
- Department of Orthopaedic Surgery, Orthopaedic Oncology Service; Massachusetts General Hospital-Harvard Medical School; Boston Massachusetts
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235
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Ng O. Iron, microbiota and colorectal cancer. Wien Med Wochenschr 2016; 166:431-436. [PMID: 27577249 DOI: 10.1007/s10354-016-0508-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/27/2016] [Indexed: 12/21/2022]
Abstract
Iron deficiency and anaemia are common in colorectal cancer. Replacement with oral or intravenous iron effectively treats this deficiency. However, mechanistic and population studies suggest that excess iron promotes colorectal carcinogenesis. Growing research into gut microbiota and dysbiosis suggests one explanation for this association. Iron is growth limiting for many pathogenic bacteria and may promote a shift in the ratio of pathogenic to protective bacteria. This may increase the toxic bacterial metabolites, promoting inflammation and carcinogenesis. This has important implications as we seek to correct anaemia in our patients.
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Affiliation(s)
- Oliver Ng
- Clinical Research Fellow, Queens Medical Centre, Nottingham Digestive Disease Centre, E Floor West Block, Derby Rd, NG7 2UH, Nottingham, UK.
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236
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Martin OA, Anderson RL, Narayan K, MacManus MP. Does the mobilization of circulating tumour cells during cancer therapy cause metastasis? Nat Rev Clin Oncol 2016; 14:32-44. [PMID: 27550857 DOI: 10.1038/nrclinonc.2016.128] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Despite progressive improvements in the management of patients with locoregionally confined, advanced-stage solid tumours, distant metastasis remains a very common - and usually fatal - mode of failure after attempted curative treatment. Surgery and radiotherapy are the primary curative modalities for these patients, often combined with each other and/or with chemotherapy. Distant metastasis occurring after treatment can arise from previously undetected micrometastases or, alternatively, from persistent locoregional disease. Another possibility is that treatment itself might sometimes cause or promote metastasis. Surgical interventions in patients with cancer, including biopsies, are commonly associated with increased concentrations of circulating tumour cells (CTCs). High CTC numbers are associated with an unfavourable prognosis in many cancers. Radiotherapy and systemic antitumour therapies might also mobilize CTCs. We review the preclinical and clinical data concerning cancer treatments, CTC mobilization and other factors that might promote metastasis. Contemporary treatment regimens represent the best available curative options for patients who might otherwise die from locally confined, advanced-stage cancers; however, if such treatments can promote metastasis, this process must be understood and addressed therapeutically to improve patient survival.
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Affiliation(s)
- Olga A Martin
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,Molecular Radiation Biology Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Robin L Anderson
- Metastasis Research Laboratory, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Kailash Narayan
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
| | - Michael P MacManus
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria 3000, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Grattan street, Melbourne, Victoria 3000, Australia
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237
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Teofili L, Valentini CG, Di Blasi R, Orlando N, Fianchi L, Zini G, Sica S, De Stefano V, Pagano L. Dose-Dependent Effect of Granulocyte Transfusions in Hematological Patients with Febrile Neutropenia. PLoS One 2016; 11:e0159569. [PMID: 27487075 PMCID: PMC4972400 DOI: 10.1371/journal.pone.0159569] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/04/2016] [Indexed: 01/17/2023] Open
Abstract
It is still under debate whether granulocyte transfusions (GTs) substantially increase survival in patients with febrile neutropenia. We retrospectively examined data relative to 96 patients with hematological malignancies receiving 491 GTs during 114 infectious episodes (IE). Patients were grouped according to the median doses of granulocytes transfused during the infectious episode (low-dose group: <1.5-x108 cells/Kg; standard-dose group: 1.5–3.0x108 cells/Kg and high-dose group: >3.0x108 cells/Kg). The impact of clinical, microbiological and GT-related variables on the infection-related mortality (IRM) was investigated. The IRM was not influenced by the number of GTs or by the total amount of granulocytes received, whereas a dose-related effect of the median dose received for IE was detected at univariate analysis (IRM of 18.4% in the standard-dose group, 44.4% in the low-dose group and 48.4% in the high-dose group, p = 0.040) and confirmed at multivariate analysis (OR 3.7, IC 95% 1.5–8.9; 0.004 for patients not receiving standard doses of GTs). Moreover, patients receiving GTs at doses lower or greater than standard had increased risk for subsequent ICU admission and reduced overall survival. The dose-related effect of GTs was confirmed in bacterial but not in fungal infections. Preliminary findings obtained from a subgroup of patients candidate to GTs revealed that levels of inflammatory response mediators increase in a dose-related manner after GTs, providing a possible explanation for the detrimental effect exerted by high-dose transfusions. GTs can constitute a valuable tool to improve the outcome of infections in neutropenic patients, provided that adequate recipient-tailored doses are supplied. Further investigations of the immunomodulatory effects of GTs are recommended.
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Affiliation(s)
- Luciana Teofili
- Institute of Hematology, Catholic University, Rome, Italy
- * E-mail:
| | | | | | | | - Luana Fianchi
- Institute of Hematology, Catholic University, Rome, Italy
| | - Gina Zini
- Institute of Hematology, Catholic University, Rome, Italy
| | - Simona Sica
- Institute of Hematology, Catholic University, Rome, Italy
| | | | - Livio Pagano
- Institute of Hematology, Catholic University, Rome, Italy
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238
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Total Intravenous Anesthesia and Transfusion: A Double Whammy? Anesthesiology 2016; 125:418-9. [DOI: 10.1097/aln.0000000000001175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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239
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Are allogeneic blood transfusions associated with decreased survival after surgical treatment for spinal metastases? Spine J 2016; 16:951-61. [PMID: 27033311 DOI: 10.1016/j.spinee.2016.03.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 03/08/2016] [Accepted: 03/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Perioperative allogeneic blood transfusions have been associated with decreased survival after surgical resection of primary and metastatic cancer. Studies investigating this association for patients undergoing resection of bone metastases are scarce and controversial. PURPOSE We assessed (1) whether exposure to perioperative allogeneic blood transfusions was associated with decreased survival after surgery for spinal metastases and (2) if there was a dose-response relationship per unit of blood transfused. Additionally, we explored the risk factors associated with survival after surgery for spinal metastases. STUDY DESIGN/SETTING This is a retrospective cohort study from two university medical centers. PATIENT SAMPLE There were 649 patients who had operative treatment for metastatic disease of the spine between 2002 and 2014. Patients with lymphoma or multiple myeloma were also included. We excluded patients with a revision procedure, kyphoplasty, vertebroplasty, and radiosurgery alone. OUTCOME MEASURES The outcome measure was survival after surgery. The date of death was obtained from the Social Security Death Index and medical charts. METHODS Blood transfusions within 7 days before and 7 days after surgery were considered perioperative. A multivariate Cox proportional hazard model was used to assess the relationship between allogeneic blood transfusion as exposure versus non-exposure, and subsequently as continuous value; we accounted for clinical, laboratory, and treatment factors. RESULTS Four hundred fifty-three (70%) patients received perioperative blood transfusions, and the median number of units transfused was 3 (interquartile range: 2-6). Exposure to perioperative blood transfusion was not associated with decreased survival after accounting for all explanatory variables (hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 0.80-1.31; p=.841). Neither did we find a dose-response relationship (HR: 1.01; 95% CI: 0.98-1.04; p=.420). Other factors associated with worse survival were older age, more severe comorbidity status, lower preoperativehemoglobin level, higher white blood cell count, higher calcium level, primary tumor type, previous systemic therapy, poor performance status, presence of lung, liver, or brain metastasis, and surgical approach. CONCLUSIONS Perioperative allogeneic blood transfusions were not associated with decreased survival after surgery for spinal metastases. More liberal transfusion policies might be warranted for patients undergoing surgery for spinal metastasis, although careful consideration is needed as other complications may occur.
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240
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Mo HY, Zhong JH, Qin HG. Association of blood transfusion during resection for hepatocellular carcinoma with postoperative recurrence and overall survival: A cautionary comment. J Hepatol 2016; 65:228. [PMID: 27057989 DOI: 10.1016/j.jhep.2016.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/19/2016] [Indexed: 12/04/2022]
Affiliation(s)
- Han-Yue Mo
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Jian-Hong Zhong
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China.
| | - Hong-Gui Qin
- Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, People's Republic of China
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241
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Restrictive versus Liberal Transfusion Strategy in the Perioperative and Acute Care Settings. Anesthesiology 2016; 125:46-61. [DOI: 10.1097/aln.0000000000001162] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abstract
Background
Blood transfusions are associated with morbidity and mortality. However, restrictive thresholds could harm patients less able to tolerate anemia. Using a context-specific approach (according to patient characteristics and clinical settings), the authors conducted a systematic review to quantify the effects of transfusion strategies.
Methods
The authors searched MEDLINE, EMBASE, CENTRAL, and grey literature sources to November 2015 for randomized controlled trials comparing restrictive versus liberal transfusion strategies applied more than 24 h in adult surgical or critically ill patients. Data were independently extracted. Risk ratios were calculated for 30-day complications, defined as inadequate oxygen supply (myocardial, cerebral, renal, mesenteric, and peripheral ischemic injury; arrhythmia; and unstable angina), mortality, composite of both, and infections. Statistical combination followed a context-specific approach. Additional analyses explored transfusion protocol heterogeneity and cointerventions effects.
Results
Thirty-one trials were regrouped into five context-specific risk strata. In patients undergoing cardiac/vascular procedures, restrictive strategies seemed to increase the risk of events reflecting inadequate oxygen supply (risk ratio [RR], 1.09; 95% CI, 0.97 to 1.22), mortality (RR, 1.39; 95% CI, 0.95 to 2.04), and composite events (RR, 1.12; 95% CI, 1.01 to 1.24—3322, 3245, and 3322 patients, respectively). Similar results were found in elderly orthopedic patients (inadequate oxygen supply: RR, 1.41; 95% CI, 1.03 to 1.92; mortality: RR, 1.09; 95% CI, 0.80 to 1.49; composite outcome: RR, 1.24; 95% CI, 1.00 to 1.54—3465, 3546, and 3749 patients, respectively), but not in critically ill patients. No difference was found for infections, although a protective effect may exist. Risk estimates varied with successful/unsuccessful transfusion protocol implementation.
Conclusions
Restrictive transfusion strategies should be applied with caution in high-risk patients undergoing major surgery.
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Efficacy and Safety of Intraoperative Tranexamic Acid Infusion for Reducing Blood Transfusion During Open Radical Cystectomy. Urology 2016; 92:57-62. [DOI: 10.1016/j.urology.2016.02.044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 02/22/2016] [Accepted: 02/27/2016] [Indexed: 01/17/2023]
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Abstract
BACKGROUND Perioperative blood transfusions are associated with an increased risk of adverse postoperative outcomes through immunomodulatory effects. OBJECTIVE The purpose of this study was to identify factors associated with variation in blood transfusion use after elective colorectal resection and associated postoperative infectious complications DESIGN This was a retrospective cohort study. SETTINGS The study included elective colorectal resections in New York State from 2001 to 2013. PATIENTS The study cohort consists of 125,160 colorectal resections. Patients who were admitted nonelectively or who were admitted before the date of surgery were excluded. MAIN OUTCOME MEASURES Receipt of a perioperative allogeneic red blood cell transfusion and the secondary end points of postoperative pneumonia, surgical site infection, intra-abdominal abscess, and sepsis were measured. RESULTS The overall rate of perioperative blood transfusion for the study cohort was 13.9%. The unadjusted blood transfusion rates ranged from 2.4% to 58.7% for individual surgeons and 2.9% to 32.8% for individual hospitals. After controlling for patient-, surgeon-, and hospital-level factors in a 3-level mixed-effects multivariable model, significant variation was still present across both surgeons (p < 0.0001) and hospitals (p < 0.0001), with a 16.8-fold difference in adjusted blood transfusion rates across surgeons and a 13.2-fold difference in adjusted blood transfusion rates across hospitals. Receipt of a blood transfusion was also independently associated with pneumonia (OR = 3.23 (95% CI, 2.92-3.57)), surgical site infection (OR = 2.27 (95% CI, 2.14-2.40)), intra-abdominal abscess (OR = 2.72 (95% CI, 2.41-3.07)), and sepsis (OR = 4.51 (95% CI, 4.11-4.94)). LIMITATIONS Limitations include the retrospective design and the possibility of miscoding within administrative data. CONCLUSIONS Large surgeon- and hospital-level variations in perioperative blood transfusion use for patients undergoing colorectal resection are present despite controlling for patient-, surgeon-, and hospital-level factors. In addition, receipt of a blood transfusion was independently associated with an increased risk of postoperative infectious complications. These findings support the creation and implementation of perioperative blood transfusion protocols aimed at limiting unwarranted variation.
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Blood Transfusion Following Colorectal Resection: What Is the Real Story? Dis Colon Rectum 2016; 59:359-60. [PMID: 27050596 DOI: 10.1097/dcr.0000000000000587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kulkarni AP, Chaukar DA, Patil VP, Metgudmath RB, Hawaldar RW, Divatia JV. Does tranexamic acid reduce blood loss during head and neck cancer surgery? Indian J Anaesth 2016; 60:19-24. [PMID: 26962250 PMCID: PMC4782418 DOI: 10.4103/0019-5049.174798] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background and Aims: Transfusion of blood and blood products poses several hazards. Antifibrinolytic agents are used to reduce perioperative blood loss. We decided to assess the effect of tranexamic acid (TA) on blood loss and the need for transfusion in head and neck cancer surgery. Methods: After Institutional Review Board approval, 240 patients undergoing supramajor head and neck cancer surgeries were prospectively randomised to either TA (10 mg/kg) group or placebo (P) group. After induction, the drug was infused by the anaesthesiologist, who was blinded to allocation, over 20 min. The dose was repeated every 3 h. Perioperative (up to 24 h) blood loss, need for transfusion and fluid therapy was recorded. Thromboelastography (TEG) was performed at fixed intervals in the first 100 patients. Patients were watched for post-operative complications. Results: Two hundred and nineteen records were evaluable. We found no difference in intraoperative blood loss (TA - 750 [600–1000] ml vs. P - 780 [150–2600] ml, P = 0.22). Post-operative blood loss was significantly more in the placebo group at 24 h (P - 200 [120–250] ml vs. TA - 250 [50–1050] ml, P = 0.009), but this did not result in higher number of patients needing transfusions (TA - 22/108 and P - 27/111 patients, P = 0.51). TEG revealed faster clot formation and minimal fibrinolysis. Two patients died of causes unrelated to study drug. Incidence of wound complications and deep venous thrombosis was similar. Conclusion: In head and neck cancer surgery, TA did not reduce intraoperative blood loss or need for transfusions. Perioperative TEG variables were similar. This may be attributed to pre-existing hypercoagulable state and minimal fibrinolysis in cancer patients.
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Affiliation(s)
- Atul P Kulkarni
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Devendra A Chaukar
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vijaya P Patil
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rajendra B Metgudmath
- Department of Head and Neck Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Rohini W Hawaldar
- Clinical Research Secretariat, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Jigeeshu V Divatia
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, Maharashtra, India
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Lopez-Delgado JC, Ballus J, Esteve F, Betancur-Zambrano NL, Corral-Velez V, Mañez R, Betbese AJ, Roncal JA, Javierre C. Outcomes of abdominal surgery in patients with liver cirrhosis. World J Gastroenterol 2016; 22:2657-2667. [PMID: 26973406 PMCID: PMC4777990 DOI: 10.3748/wjg.v22.i9.2657] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/30/2015] [Accepted: 12/14/2015] [Indexed: 02/06/2023] Open
Abstract
Patients suffering from liver cirrhosis (LC) frequently require non-hepatic abdominal surgery, even before liver transplantation. LC is an important risk factor itself for surgery, due to the higher than average associated morbidity and mortality. This high surgical risk occurs because of the pathophysiology of liver disease itself and to the presence of contributing factors, such as coagulopathy, poor nutritional status, adaptive immune dysfunction, cirrhotic cardiomyopathy, and renal and pulmonary dysfunction, which all lead to poor outcomes. Careful evaluation of these factors and the degree of liver disease can help to reduce the development of complications both during and after abdominal surgery. In the emergency setting, with the presence of decompensated LC, alcoholic hepatitis, severe/advanced LC, and significant extrahepatic organ dysfunction conservative management is preferred. A multidisciplinary, individualized, and specialized approach can improve outcomes; preoperative optimization after risk stratification and careful management are mandatory before surgery. Laparoscopic techniques can also improve outcomes. We review the impact of LC on surgical outcome in non-hepatic abdominal surgeries required in this cirrhotic population before, during, and after surgery.
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Zimmitti G, Soliz J, Aloia TA, Gottumukkala V, Cata JP, Tzeng CWD, Vauthey JN. Positive Impact of Epidural Analgesia on Oncologic Outcomes in Patients Undergoing Resection of Colorectal Liver Metastases. Ann Surg Oncol 2016; 23:1003-1011. [DOI: 10.1245/s10434-015-4933-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dekker AM, Wiggers JK, Coelen RJ, van Golen RF, Besselink MG, Busch OR, Verheij J, Hollmann MW, van Gulik TM. Perioperative blood transfusion is not associated with overall survival or time to recurrence after resection of perihilar cholangiocarcinoma. HPB (Oxford) 2016; 18:262-70. [PMID: 27017166 PMCID: PMC4814620 DOI: 10.1016/j.hpb.2015.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 08/31/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND Perioperative blood transfusions have been associated with worse oncological outcome in several types of cancer. The objective of this study was to assess the effect of perioperative blood transfusions on time to recurrence and overall survival (OS) in patients who underwent curative-intent resection of perihilar cholangiocarcinoma (PHC). METHODS This retrospective cohort study included consecutive patients with resected PHC between 1992 and 2013 in a specialized center. Patients with 90-day mortality after surgery were excluded. Patients who did and did not receive perioperative blood transfusions were compared using univariable Kaplan-Meier analysis and multivariable Cox regression. RESULTS Of 145 included patients, 80 (55.2%) received perioperative blood transfusions. The median OS was 49 months for patients without and 41 months for patients with blood transfusions (P = 0.46). In risk-adjusted multivariable Cox regression analysis, blood transfusion was not associated with OS (HR 1.00, 95% CI 0.59-1.68, P = 0.99) or time to recurrence (HR 1.00, 95% CI 0.57-1.78, P = 0.99). In addition, no differences in effect were found between different types of blood products transfused. CONCLUSION Blood transfusion was not associated with survival or time to recurrence after curative resection of PHC in this series. The alleged association is presumably related to the circumstances necessitating blood transfusions.
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Affiliation(s)
- Annemiek M. Dekker
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Jimme K. Wiggers
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Robert J. Coelen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Rowan F. van Golen
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Marc G.H. Besselink
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Olivier R.C. Busch
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Joanne Verheij
- Department of Pathology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Markus W. Hollmann
- Department of Anaesthesiology, Academic Medical Centre (AMC), Amsterdam, The Netherlands
| | - Thomas M. van Gulik
- Department of Surgery, Academic Medical Centre (AMC), Amsterdam, The Netherlands,Correspondence T.M. van Gulik, AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Sergeant P, Kocharian R, Patel B, Pfefferkorn M, Matonick J. Needle-to-suture ratio, as well as suture material, impacts needle-hole bleeding in vascular anastomoses. Interact Cardiovasc Thorac Surg 2016; 22:813-6. [PMID: 26920723 DOI: 10.1093/icvts/ivw042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/18/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES The purpose of this study was to examine the influence of material variables on needle-hole bleeding in vascular anastomoses. Material variables include suture size, needle-tip geometry and diameter, needle coating, suture material and coating and swage area. We attempted to determine whether particular suture material and a reduced needle-to-suture ratio (N:S ratio) could reduce the vessel wall defect and reduce needle-hole bleeding, without changing the suture diameter used for the anastomosis. METHODS A comparative analysis was made of the needle-hole leak rate in end-to-end anastomoses of an ePTFE®-ePTFE® vascular graft with a PROLENE® polypropylene suture with HEMO-SEAL™ technology (HS, 1.84:1 N:S ratio), standard PROLENE® polypropylene suture (polypropylene 1, 2.41:1 N:S ratio), an alternate standard PROLENE® polypropylene suture (polypropylene 2, 2.06:1 N:S ratio) and a GORE-TEX™ ePTFE® suture (ePTFE® suture, 1.4:1 N:S ratio) in an ex vivo cardiopulmonary bypass pulsatile flow loop model using heparinized porcine blood. Testing was completed within the model with an activated clotting time between 250 and 500 s, at near normothermia (33-35°C) and at normotensive pressure levels (120/80 mmHg). A sample size of n = 20 was completed for each group. RESULTS The average total sample leak rate was 19.8 ± 4.5 ml/min for the HS suture, 57.2 ± 7.2 ml/min for polypropylene 1, 33.8 ± 4.1 ml/min for polypropylene 2 and 46.5 ± 10.3 ml/min for the ePTFE suture. The average needle-hole leak rates were 0.63 ± 0.13 ml/min for the HS suture, 1.94 ± 0.23 ml/min for polypropylene 1, 1.14 ± 0.14 ml/min for polypropylene 2 and 1.56 ± 0.34 ml/min for the ePTFE® suture. A two-sided 95% confidence interval for the difference in leak rates showed that there were significant differences (44-67% reduction) in favour of the HS suture when compared with the alternative needles with the same suture material and different N:S ratios, and also a reduction (59%) compared with the sample with smaller N:S ratios but different suture material. CONCLUSIONS The N:S ratio as well as the physical characteristics of the suture material are important factors in reducing needle-hole bleeding in vascular anastomoses.
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Affiliation(s)
| | | | - Bababhai Patel
- Clinical Development, Ethicon, Inc., Somerville, NJ, USA
| | - Matthew Pfefferkorn
- Advanced Modeling Group, Preclinical Research, Ethicon, Inc., Somerville, NJ, USA
| | - John Matonick
- Advanced Modeling Group, Preclinical Research, Ethicon, Inc., Somerville, NJ, USA
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Defining Transfusion Triggers and Utilization of Fresh Frozen Plasma and Platelets Among Patients Undergoing Hepatopancreaticobiliary and Colorectal Surgery. Ann Surg 2016; 262:1079-85. [PMID: 25985254 DOI: 10.1097/sla.0000000000001016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND We sought to define the overall utilization of fresh frozen plasma (FFP) and platelets and the impact on perioperative outcomes among patients undergoing hepatopancreaticobiliary and colorectal resections, as well as analyze the utility of laboratory triggers in guiding transfusion practice. METHODS We identified 3027 patients undergoing pancreatic, hepatic, and colorectal resections between 2010 and 2013 at Johns Hopkins Hospital. Data on international normalized ratio (INR) and platelet counts that triggered the perioperative utilization of these non-RBC (red blood cell) products were obtained and analyzed. RESULTS Overall FFP and platelet transfusion rates were 8.9% and 3.8%, respectively. Mean INR and platelet triggers for FFP and platelet transfusions were 1.9 ± 1.3 and 60000 ± 44000, respectively. INR triggers varied depending on resection type, patient race, and comorbidity status (all P <0.05). Nearly one-half of patients (48.0%) received FFP in the postoperative period with an INR trigger less than 1.7. FFP transfusions were independently associated with an increased length of stay [odds ratio (OR) = 3.66], perioperative morbidity (OR = 3.96) and in-hospital mortality (OR = 91.85) (all P < 0.001). Similarly, patients receiving platelets were at increased risk for worse overall perioperative outcomes (all OR >1, P <0.001). CONCLUSIONS The utilization and indication of non-RBC components vary significantly across surgical specialties. Nearly one-half of patients transfused with FFP during the postoperative period had an INR of less than 1.7, indicating possible overutilization of these products. Furthermore, the use of FFP and platelets are associated with poorer perioperative outcomes. Further studies are needed to study the impact and management of a more restrictive use of FFP and platelets on surgical patients.
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