Impact of perioperative blood transfusions on oncologic outcomes after radical cystectomy: A systematic review and meta-analysis of comparative studies
Surgical oncology. 2021;38:101592
This study aimed at systematically analyzing and evaluating the impact of perioperative blood transfusions (PBT) on oncologic outcomes of patients undergoing radical cystectomy for bladder cancer. This systematic review follows the recommendations of the Cochrane Handbook for Systematic Reviews and Interventions and was conducted in line with the PRISMA statement and the AMSTAR II criteria. A comprehensive database search was performed based on the PICO criteria. Two independent reviewers performed all screening steps and quality assessment. Risk of bias and certainty in evidence were assessed with the Newcastle Ottawa Scale for non-randomized trials and the GRADE approach. Of 1123 identified studies 20 were eligible for qualitative analysis and 15 for quantitative analysis reporting on 21,915 patients. Receiving a PBT was associated with an increased risk of all-cause mortality (hazard ratio (HR) [95% confidence interval (CI)]: 1.29 [1.18, 1.40]; p < 0.001), cancer-specific mortality (HR [CI]: 1.27 [1.15; 1.41]; p < 0.001) and disease recurrence (HR [CI]: 1.22 [1.12; 1.34]; p < 0.001). Subgroup analysis of transfusion timing revealed a significantly increased risk of mortality with intraoperative or combined intra- and postoperative transfusions compared to postoperative transfusion only for all three outcomes (p < 0.001). Leukocyte-depletion was associated with increased all-cause mortality, but not cancer-specific mortality. The administration of PBT negatively impacts oncological outcomes after radical cystectomy. Therefore, careful treatment indication and strict adherence to transfusion guidelines is encouraged in order to avoid adverse effects during the perioperative course.
Prognostic impact of perioperative blood transfusions on oncological outcomes of patients with bladder cancer undergoing radical cystectomy: A systematic review
Arab journal of urology. 2020;19(1):24-30
Objective: To conduct a systematic review of whether blood transfusions may be associated with worse outcomes for patients with bladder cancer treated with radical cystectomy (RC), as there has been a recent increase in studies addressing this clinically relevant topic. Methods: PubMed, Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE), Google Scholar, and the ClinicalTrials.gov databases were searched with pre-specified search terms for studies published between January 2010 and May 2020. The systemic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 17 studies with 19 627 patients were included after 183 records were screened for eligibility. In all, 10 studies proposed perioperative blood transfusion to be associated with impaired prognosis regarding overall survival, nine studies regarding cancer-specific and four studies regarding recurrence-free survival. The timing of blood transfusion might affect patient outcomes. Notably, several studies did not find a significant correlation between blood transfusions and prognosis. As all studies to date are of retrospective design, the grade of evidence is still limited. Conclusions: Despite the lack of prospective trials, perioperative blood transfusion may lead to worse oncological outcomes. These results, as well as known non-oncological side-effects and associated costs, are important arguments to carefully consider the indication for blood transfusion. Abbreviations BCa: bladder cancer; CSS: cancer-specific survival; HR: hazard ratio; (N)MIBC: (non-) muscle-invasive BCa; OS: overall survival; PBT, perioperative blood transfusion; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RC: radical cystectomy; RFS: recurrence-free survival.
Efficacy of post-operative intravenous iron in elective major urological surgery
Transfusion Alternatives in Transfusion Medicine. 2010;11((Suppl 2):):33. Abstract No. P43.
Preoperative epoetin alfa in colorectal surgery: a randomized, controlled study
Annals of Surgical Oncology. 2005;12((9):):718-25.
BACKGROUND Colorectal cancer patients are often anemic before surgery, and this leads to an increased requirement for allogeneic blood transfusion. This may result in transfusion-induced immunosuppression, which in turn leads to increased morbidity and possibly an increased rate of tumor relapse. We investigated the possible benefits of perioperative epoetin alfa administration in anemic patients to correct hemoglobin levels and reduce transfusion needs. METHODS A total of 223 colorectal cancer patients with anemia scheduled for surgery were randomized to a group that received epoetin alfa 150 or 300 IU/kg/day subcutaneously for 12 days (day -10 to +1) or to a control group. All received iron (200 mg/day by mouth) for 10 days before surgery. Hemoglobin levels, hematocrit, and the number of blood units transfused were recorded. RESULTS A total of 204 patients were eligible for analysis. Mean hemoglobin levels and hematocrit were significantly higher in the 300 IU/kg group than in the control group, both 1 day before surgery (hemoglobin, P = . 008; hematocrit, P = . 0005) and 1 day after surgery (hemoglobin, P = . 011; hematocrit, P = . 0008). Blood loss during and after surgery was similar in all groups. Patients who received epoetin alfa 300 IU/kg required significantly fewer perioperative transfusion units than control patients (. 81 vs. 1. 32; P = . 016) and significantly fewer postoperative units (. 87 vs. 1. 33; P = . 023). There were no significant differences in the number of units in the 150 IU/kg group. CONCLUSIONS Preoperative epoetin alfa (300 IU/day) increases hemoglobin levels and hematocrit in colorectal surgery patients. These effects are associated with a reduced need for perioperative and postoperative transfusions.
Preoperative epoetin alfa in colorectal surgery: a randomized controlled study
Transfusion Alternatives in Transfusion Medicine. 2004;6((1, Suppl):):90. Abstract No. P39.
Preoperative use of erythropoietin (rH-EPO) and determination of optimal doses in patients with benign prostatic hypertrophy for future autologous blood transfusion Japanese
Nippon Hinyokika Gakkai Zasshi - Japanese Journal of Urology. 1995;86((12):):1720-7.
BACKGROUND Recently, autologous blood transfusion has been widely endorsed, because of the adverse effects attributed to homologous blood transfusion. We found that the administration of recombinant human erythropoietin (rH-EPO) permitted the preoperative collection of an adequate volume of autologous blood in a short period of time. This reduced or eliminated the need for homologous blood transfusion. METHODS To determine optimal dosage of rH-EPO, I conducted a randomized, controlled trial in 86 patients with benign prostatic hypertrophy (BPH) scheduled for transurethral resection of the prostate (TUR-P). The patients from whom approximately 10% of their total blood volume was removed, received six different doses of rH-EPO either intravenously or subctaneously. All patients received iron sulfate 100 mg orally once a day during the study. RESULTS I found that 9,000 IU of rH-EPO given intravenously daily or 10,500 IU of rH-EPO injected subcutaneously every third day for a week were optimal dosages. These schedules ennabled us to withdraw approximately 400 ml of blood prior to operation without adverse effects. CONCLUSION I conclude that the efficacy of rH-EPO is greater when administered subcutaneously rather than intravenously. It is clear that rH-EPO increases the ability of patients about to undergo selective surgery to donate greater amounts of blood for future autologous transfusion.