Anemia and Transfusions in Patients Undergoing Surgery for Cancer

Weber, Randal S.; Jabbour, Nicolas; Martin, Robert C.G.

doi:10.1245/s10434-007-9502-9

Cited by 109 publications

(93 citation statements)

References 114 publications

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“…Its effects on the immune system and recurrence have been described. 28 Saxena et al (2009) identified risk factors for requiring massive transfusion during CRS/HIPEC, which include preoperative anemia (hemoglobin <125 g/L), impaired coagulation profile (INR ≥1.2) and high tumour burden (PCI ≥16). 18 In an attempt to avoid this adverse event, our centre routinely performs intraoperative point-of-care (POC) coagulation testing and rotational thromboelastometry (ROTEM) in theatre every 2 h to aggressively detect and correct any abnormal results.…”

Section: Discussionmentioning

confidence: 99%

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

et al. 2017

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Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) has an established role in selected patients for the treatment of peritoneal surface malignancy. However, CRS/HIPEC is associated with increased risk of morbidity and mortality. The aim of this review was to identify risk factors for post-operative mortality in an attempt to improve patient outcomes post CRS/HIPEC. This is a retrospective study of prospectively collected data on 1019 patients who underwent CRS/HIPEC by the same surgical team at St George Hospital, Kogarah, Australia, between January 1996 and July 2016.During the 20-year time-period seventeen patients (1.67%) died postoperatively. A higher peritoneal cancer index (PCI), completeness of cytoreduction (CC) score, longer operative time and a volume of intra-operative transfusion were evident in the hospital mortality group and were significantly associated with postoperative mortality on univariate analysis. Postoperative complications including infection, bleeding, pneumonia, fistula, collection and pancreatic leak were also associated with post-operative mortality. The most common cause of death was sepsis (n=15, 88.2%).It is difficult to determine pre-operative factors that can be utilized as predictors of post-operative mortality, as the overall incidence of in-hospital mortality post CRS/HIPEC was very low on our unit. Nevertheless, a cascade of events and learning curve was displayed.

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Section: Discussionmentioning

confidence: 99%

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

et al. 2017

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“…This is related to the widely studied immunosuppressive effects of allogeneic blood and the modulation of WBCs in allogenic vs. autologous transfusions [33]. A study investigating patients undergoing resection of gastric cancer randomized patients to allogeneic or autologous transfusion.…”

Section: Blood Transfusionmentioning

confidence: 99%

“…Five days after the operation, levels had returned to baseline for patients receiving autologous transfusions but remained suppressed in the allogeneic group [34]. Studies on this effect are controversial and remain inconclusive, as current literature does not clearly correlate TRIM with cancer recurrence [33,34].…”

Section: Blood Transfusionmentioning

confidence: 99%

Anesthetic Considerations for Management of Cancer Patients to Decrease Cancer Recurrence

Laudański¹,

Wei²,

Korley³

2016

J Anesth Clin Res

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Alongside the known direct, short-term effects of anesthesia in general, there is emerging evidence of an immunomodulatory effect with specific anesthetics that may decrease patient's defences against malignant neoplastic growths. This effect is especially important in the setting of surgical management of neoplasms, which is often the best option for long-term survival in patients with solid neoplasm. Many studies have speculated on the best anesthetic technique to reduce the neoplasm recurrence and promote patient survival, however, we often neglect the sympathetic stress response to neoplasia and how anesthetics modulate this effect. In this review, we study the evidence as it pertains to anesthetic techniques and pain control, particularly general vs. regional anesthesia, and opioid analgesia. At this time there is not enough evidence to support that regional anesthesia has a more favorable outcome than general anesthesia, or that opioids should not be used in neoplasm-related pain management because of their potential pro-metastatic properties secondary to opioid-induced immunosuppression. Instead, the debate over anesthetic use should be centered on adequate pain control since overwhelming evidence have shown that pain-related stress reaction mediated via β-adrenergic activation, promotes neoplastic propagation and metastasis, hence decreasing survival rates.

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“…[4] As allogeneic blood transfusion modulates the host immune system, it may also influence cancer recurrence. [77] As transfused leucocytes potentially alter circulating lymphocyte ratios and function, irradiated or leucocyte-depleted red-cells are frequently preferentially administered to oncology patients. However, even where leucocyte-depleted red cells are used, transfusion has been associated with decreased cancer-free survival and decreased overall survival in lung cancer [78] and a recent meta-analysis by Churchhouse and colleagues [79], while not reaching definitive conclusions, suggested an association between transfusion and decreased cancer-free survival.…”

Section: Interaction Between the Immune System And Cancer Cellsmentioning

confidence: 99%

Does regional anaesthesia and analgesia or opioid analgesia influence recurrence after primary cancer surgery? An update of available evidence

Ash

Buggy

2013

Best Practice & Research Clinical Anaesthesiology

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Cancer continues to be a key cause of morbidity and mortality worldwide and its overall incidence continues to increase. Anaesthetists are increasingly faced with the challenge of managing cancer patients, either for surgical resection to debulk or excise the primary tumour, surgical emergencies in patients on chemotherapy, or for the analgesic management of disease-or treatmentrelated chronic pain. Metastatic recurrence is a concern. Surgery and a number of perioperative factors are suspected to accelerate tumour growth and potentially increase the risk of metastatic recurrence. Retrospective analyses have suggested an association between anaesthetic technique and cancer outcomes, and anaesthetists have sought to ameliorate the consequences of surgical trauma and minimize the impact of anaesthetic interventions. Just how anaesthesia and analgesia impact cancer recurrence and consequent survival is very topical, as understanding the potential mechanisms and interactions impacts on the anaesthetist's ability to contribute to the successful outcome of oncological interventions . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 ABSTRACT Cancer continues to be a key cause of morbidity and mortality worldwide and its overall incidence continues to increase. Anaesthetists are increasingly faced with the challenge of managing cancer patients, either for surgical resection to debulk or excise the primary tumour, surgical emergencies in patients on chemotherapy, or for the analgesic management of disease-or treatment-related chronic pain. Metastatic recurrence is a concern. Surgery and a number of perioperative factors are suspected to accelerate tumour growth and potentially increase the risk of metastatic recurrence. Retrospective analyses have suggested an association between anaesthetic technique and cancer outcomes, and anaesthetists have sought to ameliorate the consequences of surgical trauma and minimize the impact of anaesthetic interventions. Just how anaesthesia and analgesia impact cancer recurrence and consequent survival is very topical, as understanding the potential mechanisms and interactions impacts on the anaesthetist"s ability to contribute to the successful outcome of oncological interventions.

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Anemia and Transfusions in Patients Undergoing Surgery for Cancer

Cited by 109 publications

References 114 publications

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

Treatment-related post-operative mortality after cytoreductive surgery and perioperative intraperitoneal chemotherapy

Anesthetic Considerations for Management of Cancer Patients to Decrease Cancer Recurrence

Does regional anaesthesia and analgesia or opioid analgesia influence recurrence after primary cancer surgery? An update of available evidence

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