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Wright GP, Wolf AM, Waldherr TL, Ritz-Holland D, Laney ED, Chapman HA, Lane BR, Assifi MM, Chung MH. Preoperative tranexamic acid does not reduce transfusion rates in major oncologic surgery: Results of a randomized, double-blind, and placebo-controlled trial. J Surg Oncol 2020; 122:1037-1042. [PMID: 32737893 DOI: 10.1002/jso.26142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Allogeneic blood transfusions are associated with worse postoperative outcomes in oncologic surgery. The aim of this study was to introduce a preoperative intervention to reduce transfusion rates in this population. METHODS Adult patients undergoing major oncologic surgery in five categories with similar transfusion rates were recruited. Enrollees received a single preoperative intravenous dose of placebo or tranexamic acid (1000 mg). The primary outcome measure was perioperative transfusion rate. Secondary outcome measures included: estimated blood loss, thromboembolic events, morbidity, hospital length of stay, and readmission rate. RESULTS Seventy-six patients were enrolled, 39 in the tranexamic acid group and 37 in the placebo group, respectively. Demographics and surgery type were equivalent between groups. The transfusion rates were 8 out of 39 (20.5%) in the tranexamic acid group and 5 out of 37 (13.5%) in the placebo group, respectively (P = .418). Median estimated blood loss was 400 mL (interquartile range [IQR] = 150-600) in the tranexamic acid group compared with 300 mL (IQR = 150-800) in the placebo group (P = .983). There was one pulmonary embolism in each arm and no deep venous thrombosis (P > .999). CONCLUSION Preoperative administration of tranexamic acid at a 1000 mg intravenous dose does not decrease transfusion rates or estimated blood loss in patients undergoing major oncologic surgery.
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Affiliation(s)
- Gerald Paul Wright
- Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, Michigan.,Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Andrea M Wolf
- Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, Michigan.,Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Tracy L Waldherr
- Department of Research Services, Spectrum Health Cancer Center, Grand Rapids, Michigan
| | - Deborah Ritz-Holland
- Department of Research Services, Spectrum Health Cancer Center, Grand Rapids, Michigan
| | - Eric D Laney
- Department of Research Services, Spectrum Health Cancer Center, Grand Rapids, Michigan
| | - Heidi A Chapman
- Department of Research Services, Spectrum Health Cancer Center, Grand Rapids, Michigan
| | - Brian R Lane
- Division of Urology, Spectrum Health Medical Group, Grand Rapids, Michigan
| | - M Mura Assifi
- Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, Michigan.,Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Mathew H Chung
- Division of Surgical Oncology, Spectrum Health Medical Group, Grand Rapids, Michigan.,Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan
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Lane BR, Bissonnette J, Waldherr T, Ritz-Holland D, Chesla D, Cottingham SL, Alberta S, Liu C, Thompson AB, Graveel C, MacKeigan JP, Noyes SL, Smith J, Lakhani N, Steensma MR. Development of a Center for Personalized Cancer Care at a Regional Cancer Center: Feasibility Trial of an Institutional Tumor Sequencing Advisory Board. J Mol Diagn 2015; 17:695-704. [PMID: 26331835 DOI: 10.1016/j.jmoldx.2015.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 06/17/2015] [Accepted: 07/01/2015] [Indexed: 11/19/2022] Open
Abstract
Next-generation sequencing (NGS) capabilities can affect therapeutic decisions in patients with complex, advanced, or refractory cancer. We report the feasibility of a tumor sequencing advisory board at a regional cancer center. Specimens were analyzed for approximately 2800 mutations in 50 genes. Outcomes of interest included tumor sequencing advisory board function and processes, timely discussion of results, and proportion of reports having potentially actionable mutations. NGS results were successfully generated for 15 patients, with median time from tissue processing to reporting of 11.6 days (range, 5 to 21 days), and presented at a biweekly multidisciplinary tumor sequencing advisory board. Attendance averaged 19 participants (range, 12 to 24) at 20 days after patient enrollment (range, 10 to 30 days). Twenty-seven (range, 1 to 4 per patient) potentially actionable mutations were detected in 11 of 15 patients: TP53 (n = 6), KRAS (n = 4), MET (n = 3), APC (n = 3), CDKN2A (n = 2), PTEN (n = 2), PIK3CA, FLT3, NRAS, VHL, BRAF, SMAD4, and ATM. The Hotspot Panel is now offered as a clinically available test at our institution. NGS results can be obtained by in-house high-throughput sequencing and reviewed in a multidisciplinary tumor sequencing advisory board in a clinically relevant manner. The essential components of a center for personalized cancer care can support clinical decisions outside the university.
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Affiliation(s)
- Brian R Lane
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, Michigan; Division of Urology, Spectrum Health System, Grand Rapids, Michigan.
| | - Jeffrey Bissonnette
- Advanced Technology Laboratory, Molecular Diagnostics, Spectrum Health System, Grand Rapids, Michigan
| | - Tracy Waldherr
- Office of Clinical Research Operations, Spectrum Health System, Grand Rapids, Michigan
| | - Deborah Ritz-Holland
- Office of Clinical Research Operations, Spectrum Health System, Grand Rapids, Michigan
| | - Dave Chesla
- Spectrum Health Universal Biorepository, Spectrum Health System, Grand Rapids, Michigan
| | - Sandra L Cottingham
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Spectrum Health Universal Biorepository, Spectrum Health System, Grand Rapids, Michigan; Department of Pathology, Spectrum Health System, Grand Rapids, Michigan
| | - Sheryl Alberta
- Advanced Technology Laboratory, Molecular Diagnostics, Spectrum Health System, Grand Rapids, Michigan
| | - Cong Liu
- Advanced Technology Laboratory, Molecular Diagnostics, Spectrum Health System, Grand Rapids, Michigan
| | - Amanda B Thompson
- Advanced Technology Laboratory, Molecular Diagnostics, Spectrum Health System, Grand Rapids, Michigan
| | - Carrie Graveel
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, Michigan
| | - Jeffrey P MacKeigan
- Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, Michigan
| | - Sabrina L Noyes
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Division of Urology, Spectrum Health System, Grand Rapids, Michigan
| | - Judy Smith
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; Department of Oncology, Spectrum Health System, Grand Rapids, Michigan
| | - Nehal Lakhani
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Department of Hematology/Oncology, Cancer and Hematology Centers of West Michigan, Grand Rapids, Michigan
| | - Matthew R Steensma
- Spectrum Health Cancer Center, Spectrum Health System, Grand Rapids, Michigan; Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan; Center for Cancer and Cell Biology, Van Andel Research Institute, Grand Rapids, Michigan; Department of Orthopaedic Oncology, Spectrum Health System, Grand Rapids, Michigan
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