Impact of perioperative blood transfusions on oncologic outcomes after radical cystectomy: A systematic review and meta-analysis of comparative studies

Uysal, Daniel; Egen, Luisa; Grilli, Maurizio; Wessels, Frederik; Lenhart, Maximilian; Michel, Maurice Stephan; Kriegmair, Maximilian C.; Kowalewski, Karl‐Friedrich

doi:10.1016/j.suronc.2021.101592

Cited by 10 publications

(20 citation statements)

References 45 publications

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“… 89 , 90 Although controversial, these oncologic outcomes have also been demonstrated for patients with BC undergoing RC. 91 – 93 The AUA currently recommends avoiding intraoperative blood transfusions, if possible. 94 However, the effects of transfusion on surgical outcomes related to the goals of ERAS are not well understood.…”

Section: Targeted Components Of Erasmentioning

confidence: 99%

Updates on enhanced recovery after surgery for radical cystectomy

Lee

Patel

Srivastava

et al. 2022

Therapeutic Advances in Urology

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Enhanced Recovery after Surgery (ERAS) is a multimodal pathway that provides evidence-based guidance for improving perioperative care and outcomes in patients undergoing surgery. In 2013, the ERAS society released its original guidelines for radical cystectomy (RC) for bladder cancer (BC), adopting much of its supporting data from colorectal literature. In the last decade, growing interest in ERAS has increased RC-specific ERAS research, including prospective randomized controlled trials (RCTs). Collective data suggest ERAS contributes to improved complication rates, decreased hospital length-of-stay, and/or time to bowel recovery. Various institutions have adopted modified versions of the ERAS pathway, yet there remains a lack of consensus on the efficacy of specific ERAS items and standardization of the protocol. In this review, we summarize updated evidence and practice patterns of ERAS pathways for RC since the introduction of the original 2013 guidelines. Novel target interventions, including use of immunonutrition, prehabilitation, alvimopan, and methods of local analgesia are reviewed. Finally, we discuss barriers to implementing and future steps in advancing the ERAS movement.

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Section: Targeted Components Of Erasmentioning

confidence: 99%

Updates on enhanced recovery after surgery for radical cystectomy

Lee

Patel

Srivastava

et al. 2022

Therapeutic Advances in Urology

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“…Hence most patients suffering from IDA will require at least 1000 mg of iron to correct anaemia and replete iron stores. The disadvantages of transfusions include infection risk, 4 possible immune response 5 and higher systematic recurrence after oncological surgery 6–9 …”

Section: Introductionmentioning

confidence: 99%

“…The disadvantages of transfusions include infection risk, 4 possible immune response 5 and higher systematic recurrence after oncological surgery. [6][7][8][9] Next-generation high-dose IV iron products, enabling doses of ≥1000 mg to be administered in a single infusion, are commercially available and have demonstrated favourable safety profiles with low rates of severe or serious hypersensitivity reactions, which had previously limited use. 10 This has improved the treatment options for managing severe iron deficiency in both hospitalised and outpatient settings.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of hypophosphataemia after ferric carboxymaltose use—A 3‐year experience from a single institution in Singapore

Chu

Cushway²,

Wong

et al. 2023

Br J Haematol

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SummaryFerric carboxymaltose (FCM) administration helps reduce transfusion requirements in the perioperative situation, which improves patient outcomes and reduces healthcare costs. However, there is increasing evidence of hypophosphataemia after FCM use. We aim to determine the incidence of hypophosphataemia after FCM administration and elucidate potential biochemical factors associated with the development of subsequent hypophosphataemia. A retrospective review of anonymised data of all FCM administrations in a single institution was conducted from August 2018 to August 2021. Each unique FCM dose administered was examined to assess its effect on Hb and serum phosphate levels within the subsequent 28 days from each FCM administration. Phosphate levels were repeatedly measured within the 28‐day interval and the lowest phosphate level within that period was determined. Patients' serum phosphate levels within 28 days of FCM administration were compared against normal serum phosphate levels within 2 weeks before FCM administration. The odds ratios of various pre‐FCM serum markers were calculated to elucidate potential biochemical predictors of post‐FCM hypophosphataemia. In 3 years, a total of 1296 doses of FCM were administered to 1069 patients. The mean improvement in Hb was 2.45 g/dL (SD = 1.94) within 28 days of FCM administration, with the mean time taken to peak Hb levels being 6.3 days (SD = 8.63), which is earlier than expected, but was observed in this study and hence reported. The incidence of hypophosphataemia <0.8 mmol/L was 22.7% (n = 186), and <0.4 mmol/L was 1.6% (n = 9). This figure is lower than the numbers reported in previously published meta‐analyses given that routine checks of serum phosphate levels were not conducted initially and hence could possibly be higher. The odds of developing hypophosphataemia (<0.8 mmol/L) were 27.7 (CI: 17.3–44.2, p < 0.0001) if baseline serum phosphate was less than 1 mmol/L. The odds of developing hypophosphataemia (<0.8 mmol/L) were 1.3 (CI: 1.08–1.59, p < 0.01) if the change in Hb levels observed after FCM administration were more than 4 g/dL. Hypophosphataemia after FCM administration is significant and FCM should be used by clinicians with caution.

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“…2 About 9 to 75% of all patients undergoing RC for BCa require allogenic perioperative blood transfusion (PBT). [3][4][5] Allogenic PBT can cause transient, yet profound immunosuppressive effects in the recipient also referred to as transfusion-related immune modulation (TRIM). 6 Numerous responsible mediators have been identified, including cytokines, eicosanoids, and growth factors like TGF-β, VEGF, or PDGF-D. 6,7 Surgical manipulation can lead to hematogenic tumor cell circulation.…”

Section: Introductionmentioning

confidence: 99%

“…6,7 However, the available literature is inconclusive about the role of PBT and the impact of intra-versus postoperative PBT 12 on oncological outcomes in patients undergoing surgery due to different types of cancer, including BCa. 5,11,[13][14][15][16][17] In the most recent meta-analysis of 15 studies including 21,915 BCa patients undergoing RC, PBT was associated with an increased risk of all-cause and cancer-specific mortality. 5 The main cause for these contradictory findings in existing retrospective studies might be an incomplete consideration of blood-donor and transfusionspecific variables including storage time of red blood cell units (BUs), 18 donor age, 19,20 and gender matching.…”

Section: Introductionmentioning

confidence: 99%

Oncological impact of perioperative blood transfusion in bladder cancer patients undergoing radical cystectomy: Do we need to consider storage time of blood units, donor age, or gender matching?

Ebner,

Fleckenstein,

Volz

et al. 2023

Transfusion

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BackgroundThe oncological impact of perioperative blood transfusions (PBTs) of patients undergoing radical cystectomy (RC) because of bladder cancer (BCa) has been a controversial topic discussed in recent years. The main cause for the contradictory findings of existing studies might be the missing consideration of the storage time of red blood cell units (BUs), donor age, and gender matching.Study Design and MethodsWe retrospectively analyzed BCa patients who underwent RC in our department between 2004 and 2021. We excluded patients receiving BUs before RC, >10 BUs, or RC in a palliative setting. We assessed the effect of blood donor characteristics and storage time on overall survival (OS) and cancer‐specific survival (CSS) through univariate and multivariable Cox regression analysis. We also performed a propensity score matching with patients who received BUs and patients who did not on a 1:1 ratio.ResultsWe screened 1692 patients and included 676 patients for the propensity score matching. In the multivariable analysis, PBT was independently associated with worse OS and CSS (p < .001). Postoperative transfusions were associated with better OS (p = .004) and CSS (p = .008) compared to intraoperative or mixed transfusions. However, there was no influence of blood donor age, storage time, or gender matching on prognosis.DiscussionIn our study of BCa patients undergoing RC, we demonstrate that PBT, especially if administered intraoperatively, is an independent risk factor for a worse prognosis.However, storage time, donor age, or gender matching did not negatively affect oncological outcomes. Therefore, the specific selection of blood products does not promise any benefits.

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Impact of perioperative blood transfusions on oncologic outcomes after radical cystectomy: A systematic review and meta-analysis of comparative studies

Cited by 10 publications

References 45 publications

Updates on enhanced recovery after surgery for radical cystectomy

Updates on enhanced recovery after surgery for radical cystectomy

Incidence and predictors of hypophosphataemia after ferric carboxymaltose use—A 3‐year experience from a single institution in Singapore

Oncological impact of perioperative blood transfusion in bladder cancer patients undergoing radical cystectomy: Do we need to consider storage time of blood units, donor age, or gender matching?

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