A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer Journal Article

Authors: Tanner, E. J.; Filippova, O. T.; Gardner, G. J.; Long Roche, K. C.; Sonoda, Y.; Zivanovic, O.; Fischer, M.; Chi, D. S.
Article Title: A prospective trial of acute normovolemic hemodilution in patients undergoing primary cytoreductive surgery for advanced ovarian cancer
Abstract: Objectives: Our objective was to determine the safety and efficacy of acute normovolemic hemodilution (ANH) to reduce the requirement for allogenic red blood cell (RBC) transfusions in patients undergoing primary cytoreduction for advanced ovarian cancer. Methods: Patients undergoing primary cytoreduction for advanced ovarian cancer were enrolled in a prospective trial assessing ANH at time of surgery. Intraoperative blood withdrawal was performed to a target hemoglobin of 8.0 g/dL. A standardized transfusion protocol first using autologous then allogenic blood was applied intraoperatively and throughout hospitalization according to institutional guidelines. The primary endpoint was to determine the overall rate of allogenic RBC transfusions in the intra- and postoperative periods. A predetermined allogenic RBC transfusion rate <35% was deemed a meaningful reduction from a 50% transfusion rate in historical controls. Results: Forty-one patients consented to participate. Median blood withdrawn during ANH was 1650 mL (range, 700–3000). Cytoreductive outcomes were as follows: 0 mm, 30 (73%); 1–10 mm, 8 (20%); and >10 mm, 3 (7%) residual disease. Estimated blood loss was 1000 mL (range, 150–2700). Fourteen patients (34%) received allogenic RBC transfusions intra- or postoperatively, meeting the primary endpoint. No patients were transfused outside protocol guidelines. The rate of ≥grade 3 complications (20%) and anastomotic leaks (7%) were similar to historical controls and met predefined safety thresholds. Conclusions: For patients with advanced ovarian cancer undergoing primary cytoreductive surgery, ANH appears to reduce allogenic RBC transfusion rates versus historical controls without increasing perioperative complications. Further evaluation of the technique is warranted. © 2018 Elsevier Inc.
Keywords: adult; clinical article; controlled study; aged; splenectomy; advanced cancer; hysterectomy; lymph node dissection; prospective study; ovarian cancer; cytoreductive surgery; ovary cancer; heart disease; lung disease; ovariectomy; pelvis lymphadenectomy; hemoglobin; hemoglobin blood level; practice guideline; length of stay; hemodilution; minimal residual disease; blood transfusion; surgery; colon resection; liver resection; postoperative infection; systolic blood pressure; erythrocyte transfusion; urogenital tract disease; gastrointestinal disease; distal pancreatectomy; hematologic disease; partial gastrectomy; anastomosis leakage; acute normovolemic hemodilution; peroperative complication; surgical wound; omentectomy; prospective trial; operative blood loss; human; female; priority journal; article; primary cytoreduction
Journal Title: Gynecologic Oncology
Volume: 151
Issue: 3
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2018-12-01
Start Page: 433
End Page: 437
Language: English
DOI: 10.1016/j.ygyno.2018.10.006
PROVIDER: scopus
PUBMED: 30336947
Notes: Gynecol. Oncol. -- Export Date: 2 January 2019 -- Article -- CODEN: GYNOA C2 - 30336947 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Ginger J Gardner
    131 Gardner
  2. Mary Ellen Fischer
    19 Fischer
  3. Dennis S Chi
    495 Chi
  4. Yukio Sonoda
    286 Sonoda
  5. Oliver Zivanovic
    117 Zivanovic
  6. Edward James Tanner
    40 Tanner
  7. Kara Christine Long
    55 Long