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Gupta N, Visagie M, Kajstura TJ, Han M, Trock B, Gehrie EA, Frank SM, Bivalacqua TJ. Reducing preoperative blood orders and costs for radical prostatectomy. J Comp Eff Res 2020; 9:219-226. [PMID: 32043362 DOI: 10.2217/cer-2019-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: A maximum surgical blood order schedule (MSBOS) was implemented at our institution to optimize preoperative blood ordering and reduce unnecessary blood preparation for patients undergoing radical prostatectomy (RP), a common urologic procedure. Materials & methods: We conducted a retrospective review of patients who underwent RP from 2010 to 2016 and categorized patients by date of RP (pre- or post-MSBOS) and compared preoperative blood-ordering practices. Results: After MSBOS implementation, preoperative blood orders changed from predominantly type and cross-match 2 units (53%) to no sample (56%) for robot-assisted laparoscopic RP, and from mostly type and cross-match 2 units (62%) to type and screen (75%) for open RP with resultant cost savings. Conclusion: MSBOS implementation and compliance decreases unnecessary preoperative blood orders.
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Affiliation(s)
- Natasha Gupta
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Mereze Visagie
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Tymoteusz J Kajstura
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Misop Han
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Bruce Trock
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Eric A Gehrie
- Department of Pathology (Transfusion Medicine), Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Steven M Frank
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute & Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Abu-Ghanem Y, Ramon J. Impact of perioperative blood transfusions on clinical outcomes in patients undergoing surgery for major urologic malignancies. Ther Adv Urol 2019; 11:1756287219868054. [PMID: 31447936 PMCID: PMC6691668 DOI: 10.1177/1756287219868054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/15/2019] [Indexed: 01/17/2023] Open
Abstract
The association between allogeneic perioperative blood transfusion (PBT) and decreased survival among patients undergoing various oncological surgeries has been established in various malignant diseases, including colorectal, thoracic and hepatocellular cancer. However, when focusing on urologic tumors, the significance of PBT and its adverse effect remains debatable, mainly due to inconsistency between studies. Nevertheless, the rate of PBT remains high and may reach up to 62% in patients undergoing major urologic surgeries. Hence, the relatively high rate of PBT among related operations, along with the increasing prevalence of several urologic tumors, give this topic great significance in clinical practice. Indeed, recent retrospective studies, followed by systematic reviews in both prostate and bladder cancer surgery have supported the association that has been demonstrated in several malignancies, while other major urologic malignancies, including renal cell carcinoma and upper tract urothelial carcinoma, have also been addressed retrospectively. It is only a matter of time before the data will be sufficient for qualitative systematic review/qualitative evidence synthesis. In the current study, we performed a literature review to define the association between PBT and the oncological outcomes in patients who undergo surgery for major urologic malignancies. We believe that the current review of the literature will increase awareness of the importance and relevance of this issue, as well as highlight the need for evidence-based standards for blood transfusion as well as more controlled transfusion thresholds.
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Affiliation(s)
- Yasmin Abu-Ghanem
- Department of Urology, Chaim Sheba Medical Centre, Tel-Hashomer, Ramat-Gan, 52621, Israel
| | - Jacob Ramon
- Department of Urology, Sheba Medical Centre, Ramat-Gan, Israel
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3
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Longo MA, Cavalheiro BT, de Oliveira Filho GR. Systematic review and meta-analyses of tranexamic acid use for bleeding reduction in prostate surgery. J Clin Anesth 2018; 48:32-38. [DOI: 10.1016/j.jclinane.2018.04.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 04/07/2018] [Accepted: 04/27/2018] [Indexed: 12/24/2022]
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4
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Kinnear N, O'Callaghan M, Hennessey D, Liddell H, Newell B, Bolt J, Lawrentschuk N. Intra-operative cell salvage in urological surgery: a systematic review and meta-analysis of comparative studies. BJU Int 2018; 123:210-219. [PMID: 29726092 DOI: 10.1111/bju.14373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate systematically the safety and efficacy of intra-operative cell salvage (ICS) in urology. METHODS A search of Medline, Embase and Cochrane Library to August 2017 was performed using methods pre-published on PROSPERO. Reporting followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Eligible titles were comparative studies published in English that used ICS in urology. Primary outcomes were allogeneic transfusion rates (ATRs) and tumour recurrence. Secondary outcomes were complications and cost. RESULTS Fourteen observational studies were identified, with a total of 4 536 patients. ICS was compared with no the blood conservation technique (seven studies), preoperative autologous donation (PAD; five studies) or both (two studies). Cohorts underwent open prostatectomy (11 studies), open cystectomy (two studies) or open partial nephrectomy (one study). Meta-analysis was possible only for ATRs within prostatectomy studies. In this setting, ICS reduced ATR compared with no the blood conservation technique (odds ratio [OR] 0.34, 95% confidence interval [CI] 0.15-0.76) but not PAD (OR 0.76, 95% CI 0.39-1.31). In the non-prostatectomy setting, ATRs amongst patients who underwent ICS were significantly higher or similar in one and two studies, respectively. Tumour recurrence was found to be significantly less common (two studies), similar (eight studies) or not measured (four studies). All six studies reporting complications found no difference in their ICS cohorts. Regarding cost, one study from 1995 found ICS more expensive than PAD, while two more recent studies found ICS to be cheaper than no blood conservation technique. As a result of inter-study heterogeneity, meta-analyses were not possible for recurrence, complications or cost. CONCLUSION Low-level evidence exists that, compared with other blood conservation techniques, ICS reduces ATR and cost while not affecting complications. It does not appear to increase tumour recurrence post-prostatectomy, although follow-up durations were short. Small study sizes and short follow-ups mean conclusions cannot be drawn with regard to recurrence after nephrectomy or cystectomy. Randomized trials with long-term follow-up evaluating ICS in urology are required.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Michael O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, SA, Australia.,School of Medicine, University of Adelaide, Adelaide, SA, Australia.,Flinders Centre for Innovation in Cancer, Adelaide, SA, Australia
| | - Derek Hennessey
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Craigavon Area Hospital, Portadown, UK
| | - Heath Liddell
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Urology, Queen Elizabeth II Jubilee Hospital, Coopers Plains, Melbourne, Vic., Australia
| | - Bradley Newell
- Department of Urology, Austin Health, Melbourne, Vic., Australia
| | - John Bolt
- Department of Urology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Nathan Lawrentschuk
- Department of Urology, Austin Health, Melbourne, Vic., Australia.,Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia.,Olivia Newton-John Cancer Research Institute, Melbourne, Vic., Australia
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5
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Kinnear N, Heijkoop B, Hua L, Hennessey DB, Spernat D. The impact of intra-operative cell salvage during open radical prostatectomy. Transl Androl Urol 2018; 7:S179-S187. [PMID: 29928615 PMCID: PMC5989116 DOI: 10.21037/tau.2018.04.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background To examine the effect of intra-operative cell salvage (ICS) in open radical prostatectomy. Methods In this retrospective cohort study, all patients undergoing open radical prostatectomy for malignancy at our institution between 10/04/2013 and 10/04/2017 were enrolled. Patients were grouped and compared based on whether they received ICS. Primary outcomes were allogeneic transfusion rates, and disease recurrence. Secondary outcomes were complications and transfusion-related cost. Results Fifty-nine men were enrolled; 30 used no blood conservation technique, while 29 employed ICS. There were no significant differences between groups in age, pre- or post-operative haemoglobin, Charlson comorbidity index, operation duration or length of stay. Tumour characteristics were also similar between groups, including pre-operative prostate specific antigen, post-operative Gleason score, T-stage, nodal status and rates of margin positivity. Compared with controls, the ICS group had longer follow up (945 vs. 989 days; P=0.0016). The control and ICS groups were not significantly different in rates of tumour recurrence (6 vs. 3 patients; P=0.30) or complications (10 vs. 5 patients; P=0.16). While the proportion of patients receiving allogenic transfusion was similar (9 vs. 6 patients; P=0.41), fewer red blood products transfused (40 vs. 12 units) meant transfusion related costs were lower in ICS patients (AUD $47,666 vs. $37,429). Conclusions ICS reduced transfusion related costs, without affecting allogeneic transfusion rates, tumour recurrence or complication rates. These findings extend the literature supporting ICS in oncological surgery. Prospective randomised studies are needed to confirm the existing level III evidence.
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Affiliation(s)
- Ned Kinnear
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Bridget Heijkoop
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Lina Hua
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
| | | | - Daniel Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide, Australia
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6
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Nosnik IP, Gan TJ, Moul JW. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer? Expert Rev Anticancer Ther 2014; 7:1309-17. [PMID: 17892432 DOI: 10.1586/14737140.7.9.1309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.
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Affiliation(s)
- Israel P Nosnik
- Duke University School of Medicine, Division of Urology, Box 3707, Durham, NC 27710, USA.
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7
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Estrategias para la prostatectomía retropúbica radical sin transfusión en testigos de Jehová. Actas Urol Esp 2010. [DOI: 10.1016/j.acuro.2009.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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8
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Bertilsson H, Angelsen A, Viset T, Anderssen E, Halgunset J. RNA quality in fresh frozen prostate tissue from patients operated with radical prostatectomy. Scandinavian Journal of Clinical and Laboratory Investigation 2010; 70:45-53. [PMID: 20073672 DOI: 10.3109/00365510903540815] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND High-throughput technologies such as microarray have enhanced the discovery of new biomarkers in prostate cancer. However, the reliability of transcriptome analyses is limited by the RNA quality. OBJECTIVE Identification of variables influencing the RNA quality in radical prostatectomy specimens. MATERIAL AND METHODS RNA was extracted using an automatic extraction method for 354 samples from 38 fresh frozen prostate slices, and by manual extraction for 28 samples from 5 slices. RNA quality was measured using the RIN method (RNA Integrity Number). Evaluation of tissue composition was performed by light-microscopy for each sample. Age, total operative time, estimated blood loss, prostate volume, prostate specific antigen (s-PSA) and postoperative Gleason score were registered. The independent variables were correlated to the RIN score in a multiple linear regression model, taking p < 0.05 as the significance limit. RESULTS The amount of blood loss during prostatectomy and the amount of stroma in the tissue sample both correlated negatively with the RIN score (p = 0.03 and 0.02). Automatically extracted samples which were exposed to heat according to the RNA extraction protocol, had lower mean RNA quality (5.5, 1.46 SD) than manually extracted samples, not exposed to heat (8.7, 0.86 SD), suggesting degradation by temperature sensitive RNases, mainly residing in the stroma. CONCLUSION The highest RNA quality isolated by an automatic method from fresh frozen prostate tissue is obtained from patients with low peroperative blood loss and from samples with a low stromal fraction.
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Affiliation(s)
- H Bertilsson
- Department of Laboratory Medicine and Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
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9
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Abstract
Anaemia is a frequent complication of prostate cancer and of its treatments. In Europe prostate cancer accounts for the 10.8% of all malignant neoplasms. Iatrogenic hypogonadism and age-related physiologic changes along with nutritional deficits contribute to increase prevalence of prostate cancer related anaemia. The reason of the present review is to provide clinicians with all aspects of a frequent and multifactorial co-morbidity, whose effects are often underestimated. Erythropoiesis pathology and causes of anaemia in prostate cancer are reviewed. Critical issues of clinical management of anaemia in prostate cancer are discussed.
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Affiliation(s)
- Giuseppe Colloca
- Division of Medical Oncology, ASL-1 Imperiese, Ospedale Civile, Sanremo, Italy
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10
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Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database. Prostate Cancer Prostatic Dis 2009; 12:264-8. [DOI: 10.1038/pcan.2009.6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Hardy JF, Bélisle S, Van der Linden P. Efficacy and Safety of Recombinant Activated Factor VII to Control Bleeding in Nonhemophiliac Patients: A Review of 17 Randomized Controlled Trials. Ann Thorac Surg 2008; 86:1038-48. [DOI: 10.1016/j.athoracsur.2008.05.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 05/05/2008] [Accepted: 05/06/2008] [Indexed: 11/27/2022]
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12
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Zimmerman LH. Causes and consequences of critical bleeding and mechanisms of blood coagulation. Pharmacotherapy 2007; 27:45S-56S. [PMID: 17723108 DOI: 10.1592/phco.27.9part2.45s] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pharmacists who practice in the critical care setting require a solid background on the causes and consequences of bleeding, as well as the mechanisms of hemostasis. This article provides an overview of these topics. Bleeding and outcomes as a result of surgery and trauma, from medical and pharmacologic causes, and in obstetrics and gynecology are discussed. Patients with brain trauma, those with inherited and acquired bleeding disorders, and patients undergoing therapeutic anticoagulation are addressed, as these are populations at special risk for severe bleeding. Bleeding events as a result of hypothermia, acidosis, and disseminated intravascular coagulation are also discussed, as is the pathophysiology of massive blood loss. Traditional and newer cell-based models of coagulation mechanisms are described and compared. Application of this information in pharmacy practice will help ensure that therapies to manage and arrest blood loss are used appropriately in a wide variety of clinical scenarios.
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Affiliation(s)
- Lisa Hall Zimmerman
- Department of Pharmacy Services, Detroit Receiving Hospital-University Health Center, Detroit, Michigan 48201, USA.
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13
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Chang IH, Byun SS, Hong SK, Lee SE. Assessing the body mass index of patients might help to predict blood loss during radical retropubic prostatectomy in Korean men. BJU Int 2007; 99:570-4. [PMID: 17166243 DOI: 10.1111/j.1464-410x.2006.06637.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine the intraoperative blood loss and patient characteristics in patients treated with radical retropubic prostatectomy (RRP), to determine the independent risk factors that predict increased blood loss and transfusion requirements in Korean men. PATIENTS AND METHODS We retrospectively analysed the records of 264 consecutive patients who had RRP; all medical records were reviewed for various factors before RRP, including prostate volume and body mass index (BMI), and during RRP, e.g. operative duration, estimated blood loss (EBL), calculated blood loss (CBL) and neurovascular bundle preservation. We evaluated differences in clinical characteristics and intraoperative factors in patients categorised by BMI. Multivariate logistic regression analysis was used to establish the relationship between preoperative independent variables and endpoints related to a high CBL. RESULTS The mean EBL was lower than the CBL (387.3 vs 716.9 mL). When the group of men was stratified by BMI, although the difference in mean EBL (P = 0.160) and transfusion rate (P = 0.511) among normal, overweight and obese categories were not statistically significant, the difference in mean CBL (P = 0.011) and operative duration (P = 0.022) was statistically significantly higher in overweight and obese men. Patients who had their neurovascular bundles preserved had no statistically differences in CBL, EBL and operative duration from those with did not. The multivariate logistic regression analysis showed that BMI was the only preoperative variable that predicted a high CBL. CONCLUSIONS The EBL was underestimated by the CBL, and the BMI was the only predictor before RRP of blood loss during RRP in these Korean men.
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Affiliation(s)
- In Ho Chang
- Department of Urology, Seoul National University Bundang Hospital, Gumi-dong, Bundang-gu, Seongnam, Kyunggi-do, Korea 463-707
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14
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Nieder AM, Carmack AJK, Sved PD, Kim SS, Manoharan M, Soloway MS. Intraoperative cell salvage during radical prostatectomy is not associated with greater biochemical recurrence rate. Urology 2005; 65:730-4. [PMID: 15833517 DOI: 10.1016/j.urology.2004.10.062] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2004] [Revised: 10/06/2004] [Accepted: 10/27/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To evaluate the risk of long-term biochemical recurrence for patients who receive cell-salvaged blood. Radical retropubic prostatectomy (RRP) is historically associated with the potential for significant blood loss. Different blood management strategies include blood donation, hemodilution, preoperative erythropoietin, and intraoperative cell salvage (IOCS). Oncologic surgeons have been reluctant to use IOCS because of the potential risk of tumor dissemination. METHODS We retrospectively analyzed an RRP database and compared those who did and did not receive cell-salvaged blood by baseline parameters, pathologic outcomes, and biochemical recurrence. We also stratified our patients according to the risk of recurrence. RESULTS A total of 1038 patients underwent RRP between 1992 and 2003. Of these, 265 (25.5%) received cell-salvaged blood and 773 (74.5%) did not. The two groups had similar baseline characteristics. No differences were found between the two groups when compared by risk of seminal vesicle invasion or positive surgical margins. Those who received cell-salvaged blood had a lower risk of extraprostatic extension. The median follow-up for all patients was 40.2 months. The overall risk of biochemical recurrence at 5 years for those who did and did not receive cell-salvaged blood was 15% and 18%, respectively (P = 0.76). No significant differences were found in the risk of biochemical recurrence when patients were stratified according to low, intermediate, and high risk. CONCLUSIONS IOCS is a safe and effective blood management strategy for patients undergoing RRP. The risk of biochemical recurrence was not increased for those who received cell-salvaged blood. Concerns about spreading tumor cells by way of IOCS would seem unwarranted.
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Affiliation(s)
- Alan M Nieder
- Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA
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15
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Lepage JY, Rivault O, Karam G, Malinovsky JM, Le Gouedec G, Cozian A, Malinge M, Pinaud M. [Anaesthesia and prostate surgery]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2005; 24:397-411. [PMID: 15826790 DOI: 10.1016/j.annfar.2005.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 01/30/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To review the current data about anaesthetic management in prostate surgery with special regards on analysis and prevention of specific risks, appropriate anaesthetic procedure keeping with surgery and patient, recognition and treatment of adverse events. DATA SOURCES AND EXTRACTION The Pubmed database was searched for articles (1990-2004) combined with references analysis of major articles on the field. DATA SYNTHESIS It is strongly recommended to settle germfree urine in the preoperative period. The thromboembolic risk of radical retropubic prostatectomy for cancer parallels lower abdomen oncologic surgery and is prolonged. Preoperative evaluation of cardiovascular, respiratory, neurological and metabolic comorbidity is a source of prognostic information and an essential tool in the management of elderly patients with prostate disease. Extreme patient positioning applied in prostate surgery induces haemodynamic and respiratory changes and are associated with severe muscular and nervous injuries. The laparoscopic access for radical prostatectomy is a growing alternative to the open surgical procedure. Acute normovolaemic haemodilution is a consistent and cost-effective blood conservation strategy in reducing allogenic blood transfusion for radical retropubic prostatectomy. Whether open transvesical or transurethral prostatectomy for treatment of benign hypertrophy depends on the size of the gland: transurethral resection is safe up to 80 g. Intrathecal anaesthesia with a T9 cephalad spread of sensory block, produces adequate conditions for transurethral prostatectomy and allows a rapid diagnosis of irrigating fluid absorption syndrome. In spite of recommended preoperative antibiotic prophylaxis, bacteriemias are frequent during transurethral prostate resection.
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Affiliation(s)
- J Y Lepage
- Service d'anesthésie et de réanimation chirurgicale, Hôtel-Dieu, 44093 Nantes, France.
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16
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Covin RB, Ambruso DR, England KM, Kelher MR, Mehdizadehkashi Z, Boshkov LK, Masuno T, Moore EE, Kim FJ, Silliman CC. Hypotension and acute pulmonary insufficiency following transfusion of autologous red blood cells during surgery: a case report and review of the literature. Transfus Med 2005; 14:375-83. [PMID: 15500457 DOI: 10.1111/j.0958-7578.2004.00529.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Transfusion of autologous blood is associated with fewer complications, although all untoward events of transfusion may not be negated with this strategy. We report a case of acute pulmonary insufficiency and hypotension following transfusion of autologous packed red blood cells (PRBCs) in a patient, who was undergoing major surgery. Anti-HLA class-I and class-II and anti-granulocyte antibodies were measured in the unit and in the recipient. Neutrophil (PMN)-priming activity was measured as the augmentation of the formyl-Met-Leu-Phe-activated respiratory burst. No immunoglobulins were identified; however, significant lipid-priming activity was present in the implicated, autologous PRBC unit that primed PMNs from both healthy people and the recipient. In addition, lipids, identical to those that accumulate during PRBC storage, caused significant hypotension when infused into rats at similar concentrations found in stored PRBCs. We conclude that the observed transfusion-related acute lung injury reaction with significant hypotension may be the result of two independent events: the first is related to inherent host factors, in this case major surgery, and the second is the infusion of lipids that accumulate during the routine storage of PRBCs.
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Affiliation(s)
- R B Covin
- Bonfils Blood Center, University of Colorado School of Medicine, Denver, CO, USA
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17
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Nieder AM, Simon MA, Kim SS, Manoharan M, Soloway MS. Intraoperative cell salvage during radical prostatectomy: a safe technique for Jehovahs witnesses. Int Braz J Urol 2004; 30:377-9. [PMID: 15610568 DOI: 10.1590/s1677-55382004000500003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2004] [Accepted: 10/20/2004] [Indexed: 11/21/2022] Open
Abstract
Radical retropubic prostatectomy (RRP) is an operation historically associated with the potential for significant blood loss. Patients who refuse a blood transfusion, such as Jehovah's witnesses, may be only offered radiation therapy as potentially curative treatment for prostate cancer because of the potential for a transfusion. Intraoperative cell salvage (IOCS) is an effective blood management strategy for patients who are not willing to accept predonated autologous or allergenic blood. We present our management for Jehovah's Witness patients with clinically localized prostate cancer, emphasizing our blood management approach. This is the first such report.
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Affiliation(s)
- Alan M Nieder
- Department of Urology, University of Miami School of Medicine, Miami, Florida 33101, USA
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18
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Holzbeierlein JM, Porter HJ, Thrasher JB. The craft of urologic surgery: modern radical perineal prostatectomy. Urol Clin North Am 2004; 31:629-41, xi-xii. [PMID: 15313071 DOI: 10.1016/j.ucl.2004.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Radical perineal prostatectomy (RPP) is the original approach used by urologists for removing the entire prostate for cancer treatment. From its original description approximately 100 years ago, it has gone through periods of increased and decreased popularity. RPP has not been performed as commonly in the United States since the late 1970s, with the introduction of the radical retropubic prostatectomy. With increased emphasis on reducing morbidity associated with radical prostatectomy by less-invasive techniques, however, more surgeons are revisiting RPP. As discussed in this article, RPP offers several advantages over the retropubic or laparoscopic approach for certain patients.
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Affiliation(s)
- Jeffrey M Holzbeierlein
- Department of Urology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mail Stop 3016, Kansas City, KS 66160, USA.
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