Evaluation of perioperative parameters in patients undergoing radical cystectomy urinary diversion surgery for bladder cancer
Abstract
Purpose: The aim of this study was to evaluate the effect of red blood cell transfusion and/or inotropic/vasopressor agent infusion during intraoperative and postoperative first 24-hour period on 30-day and one-year survival.
Materials and Methods: In the final analysis, 133 patients who underwent radical cystectomy and urinary diversion surgery between November 2011 and January 2019 were included in this study. Perioperative anesthesia management early postoperative intensive care patient follow-ups were based on.
Results: A statistically significant relationship was found between intraoperative red blood cell transfusion and one-year mortality rates. A statistically significant relationship was found between red blood cell transfusion in the intensive care unit and postoperative 30-day mortality rates. The relationship between vasopressor/inotrope agent infusion in intensive care unit and postoperative 30-day mortality was statistically significant.
Conclusion: In radical cystectomy and urinary diversion, intraoperative red blood cell and/or inotrope/vasopressor drug administration, and red blood cell transfusion within first 24 postoperative hours in intensive care unit are associated with lower survival rates in both early and late periods. Future studies should focus on developing and implementing different strategies for perioperative blood management and maintenance of patient hemodynamics that may affect early and late outcomes.
Keywords
Inotrope/vasopressor infusion mortality radical cystectomy surgery red blood cell transfusion
Supporting Institution
This study was approved by the Baskent University Medical and Health Sciences Research Board (Project no: KA20 /72) and was funded by the Baskent University Research Fund.
Project Number
Project no: KA20 /72
References
- 1. Matulewicz RS, Brennan J, Pruthi RS, Kundu SD, Gonzalez CM, Meeks JJ. Radical Cystectomy Perioperative Care Redesign. Urology. 2015;86:1076-86.
- 2. Weingarten TN, Taccolini AM, Ahle ST, et al. Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study. Can J Anaesth. 2016;63:584-95.
- 3. Almassi N, Bochner BH. Ileal conduit or orthotopic neobladder: selection and contemporary patterns of use. Curr Opin Urol. 2020;30:415-20.
- 4. Razdan S, Sljivich M, Pfail J, Wiklund PK, Sfakianos JP, Waingankar N. Predicting morbidity and mortality after radical cystectomy using risk calculators: A comprehensive review of the literature. Urol Oncol. 2021;39:109-20.
- 5. Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs. 2021;37:151104.
- 6. Ozyuvaci E, Altan A, Karadeniz T, Topsakal M, Besisik A, Yucel M. General anesthesia versus epidural and general anesthesia in radical cystectomy. Urol Int. 2005;74:62-7.
- 7. Lekprasert V, Yapanan L, Ittichaikulthol W, Buachai R, Soisod P, Sophonsritsuk A. Perioperative Intravenous Patient-Controlled Analgesic Efficacy of Morphine with Combined Nefopam and Parecoxib versus Parecoxib in Gynecologic Surgery: A Randomized, Double-Blind Study. Anesthesiol Res Pract. 2021;2021:5461890.
- 8. Othman AH, Ahmed DG, Abd El-Rahman AM, El Sherif FA, Mansour S, Aboeleuon E. Effect of Preperitoneal Versus Epidural Analgesia on Postoperative Inflammatory Response and Pain Following Radical Cystectomy: A Prospective, Randomized Trial. Clin J Pain. 2019;35:328-34.
- 9. Chang SS, Smith JA, Jr., Wells N, Peterson M, Kovach B, Cookson MS. Estimated blood loss and transfusion requirements of radical cystectomy. J Urol. 2001;166:2151-4.
- 10. Parekh DJ, Gilbert WB, Koch MO, Smith JA, Jr. Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality. Urology. 2000;55:852-5.
- 11. Hanash KA, Peracha AM, Al-Zahrani HM, et al. Radical cystectomy: minimizing operative blood loss with a "stapling technique". Urology. 2000;56:488-91.
- 12. Koch MO, Seckin B, Smith JA, Jr. Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol. 1995;154:996-1001.
- 13. Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914-21.
- 14. Hollenbeck BK, Miller DC, Taub D, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol. 2005;174:1231-7; discussion 7.
- 15. Latchana N, Hirpara DH, Hallet J, Karanicolas PJ. Red blood cell transfusion in liver resection. Langenbecks Arch Surg. 2019;404:1-9.
- 16. Zhang W, Zheng Y, Yu K, Gu J. Liberal Transfusion versus Restrictive Transfusion and Outcomes in Critically Ill Adults: A Meta-Analysis. Transfus Med Hemother. 2021;48:60-8.
- 17. Ghio M, Contini P, Ubezio G, Mazzei C, Puppo F, Indiveri F. Immunomodulatory effects of blood transfusions: the synergic role of soluble HLA Class I free heavy-chain molecules detectable in blood components. Transfusion. 2008;48:1591-7.
- 18. Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013;110:690-701.
- 19. Josien R, Douillard P, Guillot C, et al. A critical role for transforming growth factor-beta in donor transfusion-induced allograft tolerance. J Clin Invest. 1998;102:1920-6.
- 20. Kriebardis A, Antonelou M, Stamoulis K, Papassideri I. Cell-derived microparticles in stored blood products: innocent-bystanders or effective mediators of post-transfusion reactions? Blood Transfus. 2012;10 Suppl 2:s25-38 . 21. Said AS, Rogers SC, Doctor A. Physiologic Impact of Circulating RBC Microparticles upon Blood-Vascular Interactions. Front Physiol. 2017;8:1120.
- 22. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev. 2006CD005033.
- 23. Bennett S, Baker LK, Martel G, et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford). 2017;19:321-30.
- 24. Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012;256:235-44.
- 25. Zuckerman J, Coburn N, Callum J, et al. Association of perioperative red blood cell transfusions with all-cause and cancer-specific death in patients undergoing surgery for gastrointestinal cancer: Long-term outcomes from a population-based cohort. Surgery. 2021.
- 26. Diamantopoulos LN, Sekar RR, Holt SK, et al. Patterns and timing of perioperative blood transfusion and association with outcomes after radical cystectomy. Urol Oncol. 2021.
- 27. Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326-41; discussion 41-3.
- 28. Deng C, Bellomo R, Myles P. Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery. Br J Anaesth. 2020;124:513-24.
- 29. Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care. 2020;24:488.
- 30. Mizota T, Dong L, Takeda C, et al. Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research. Anesth Analg. 2019;129:679-85.
Mesane kanserinde radikal sistektomi üriner diversiyon operasyonu yapılan hastalarda perioperatif parametrelerin değerlendirilmesi
Abstract
Amaç: Bu çalışmada intraoperatif ve postoperatif ilk 24 saatlik dönemde eritrosit transfüzyonu ve/veya inotropik/vazopresör ajan infüzyonunun 30 günlük ve bir yıllık sağkalımı etkisinin araştırılması amaçlanmıştır.
Gereç ve Yöntem: Bu çalışmaya final analizinde Kasım 2011 ile Ocak 2019 arasında radikal sistektomi ve üriner diversiyon operasyonu geçiren 133 hasta dahil edildi. Perioperatif anestezi yönetimi erken postoperatif yoğun bakım hasta takipleri esas alındı.
Bulgular: İntraoperatif kırmızı kan hücresi transfüzyonu ile bir yıllık mortalite oranları arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur. Yoğun bakım ünitesinde yapılan eritrosit transfüzyonu ile postoperatif 30 günlük mortalite oranları arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur. Yoğun bakım ünitesinde vazopressör/inotrop ajan infüzyonu ile postoperatif 30 günlük mortalite arasında istatistiksel olarak anlamlı bir ilişki bulunmuştur.
Sonuç: Radikal sistektomi ve üriner diversiyon operasyonu geçiren hastalarda intraoperatif eritrosit, inotrop/vazopresör ilaç uygulaması ve yoğun bakımda postoperatif ilk 24 saat içinde eritrosit transfüzyonu hem erken hem de geç dönemde daha düşük sağkalım oranları ile ilişkilidir. Gelecekteki çalışmalar, perioperatif kan yönetimi ve hasta hemodinamisinin korunması ile ilgili erken ve geç dönem sonuçları etkileyebilecek farklı stratejiler geliştirmeye ve uygulamaya odaklanmalıdır.
Keywords
Inotrope/vasopressor infusion mortality radical cystectomy surgery red blood cell transfusion
Project Number
Project no: KA20 /72
References
- 1. Matulewicz RS, Brennan J, Pruthi RS, Kundu SD, Gonzalez CM, Meeks JJ. Radical Cystectomy Perioperative Care Redesign. Urology. 2015;86:1076-86.
- 2. Weingarten TN, Taccolini AM, Ahle ST, et al. Perioperative management and oncological outcomes following radical cystectomy for bladder cancer: a matched retrospective cohort study. Can J Anaesth. 2016;63:584-95.
- 3. Almassi N, Bochner BH. Ileal conduit or orthotopic neobladder: selection and contemporary patterns of use. Curr Opin Urol. 2020;30:415-20.
- 4. Razdan S, Sljivich M, Pfail J, Wiklund PK, Sfakianos JP, Waingankar N. Predicting morbidity and mortality after radical cystectomy using risk calculators: A comprehensive review of the literature. Urol Oncol. 2021;39:109-20.
- 5. Joensen UN, Maibom SL, Poulsen AM. Surgical Management of Muscle Invasive Bladder Cancer: A Review of Current Recommendations. Semin Oncol Nurs. 2021;37:151104.
- 6. Ozyuvaci E, Altan A, Karadeniz T, Topsakal M, Besisik A, Yucel M. General anesthesia versus epidural and general anesthesia in radical cystectomy. Urol Int. 2005;74:62-7.
- 7. Lekprasert V, Yapanan L, Ittichaikulthol W, Buachai R, Soisod P, Sophonsritsuk A. Perioperative Intravenous Patient-Controlled Analgesic Efficacy of Morphine with Combined Nefopam and Parecoxib versus Parecoxib in Gynecologic Surgery: A Randomized, Double-Blind Study. Anesthesiol Res Pract. 2021;2021:5461890.
- 8. Othman AH, Ahmed DG, Abd El-Rahman AM, El Sherif FA, Mansour S, Aboeleuon E. Effect of Preperitoneal Versus Epidural Analgesia on Postoperative Inflammatory Response and Pain Following Radical Cystectomy: A Prospective, Randomized Trial. Clin J Pain. 2019;35:328-34.
- 9. Chang SS, Smith JA, Jr., Wells N, Peterson M, Kovach B, Cookson MS. Estimated blood loss and transfusion requirements of radical cystectomy. J Urol. 2001;166:2151-4.
- 10. Parekh DJ, Gilbert WB, Koch MO, Smith JA, Jr. Continent urinary reconstruction versus ileal conduit: a contemporary single-institution comparison of perioperative morbidity and mortality. Urology. 2000;55:852-5.
- 11. Hanash KA, Peracha AM, Al-Zahrani HM, et al. Radical cystectomy: minimizing operative blood loss with a "stapling technique". Urology. 2000;56:488-91.
- 12. Koch MO, Seckin B, Smith JA, Jr. Impact of a collaborative care approach to radical cystectomy and urinary reconstruction. J Urol. 1995;154:996-1001.
- 13. Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914-21.
- 14. Hollenbeck BK, Miller DC, Taub D, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol. 2005;174:1231-7; discussion 7.
- 15. Latchana N, Hirpara DH, Hallet J, Karanicolas PJ. Red blood cell transfusion in liver resection. Langenbecks Arch Surg. 2019;404:1-9.
- 16. Zhang W, Zheng Y, Yu K, Gu J. Liberal Transfusion versus Restrictive Transfusion and Outcomes in Critically Ill Adults: A Meta-Analysis. Transfus Med Hemother. 2021;48:60-8.
- 17. Ghio M, Contini P, Ubezio G, Mazzei C, Puppo F, Indiveri F. Immunomodulatory effects of blood transfusions: the synergic role of soluble HLA Class I free heavy-chain molecules detectable in blood components. Transfusion. 2008;48:1591-7.
- 18. Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013;110:690-701.
- 19. Josien R, Douillard P, Guillot C, et al. A critical role for transforming growth factor-beta in donor transfusion-induced allograft tolerance. J Clin Invest. 1998;102:1920-6.
- 20. Kriebardis A, Antonelou M, Stamoulis K, Papassideri I. Cell-derived microparticles in stored blood products: innocent-bystanders or effective mediators of post-transfusion reactions? Blood Transfus. 2012;10 Suppl 2:s25-38 . 21. Said AS, Rogers SC, Doctor A. Physiologic Impact of Circulating RBC Microparticles upon Blood-Vascular Interactions. Front Physiol. 2017;8:1120.
- 22. Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev. 2006CD005033.
- 23. Bennett S, Baker LK, Martel G, et al. The impact of perioperative red blood cell transfusions in patients undergoing liver resection: a systematic review. HPB (Oxford). 2017;19:321-30.
- 24. Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012;256:235-44.
- 25. Zuckerman J, Coburn N, Callum J, et al. Association of perioperative red blood cell transfusions with all-cause and cancer-specific death in patients undergoing surgery for gastrointestinal cancer: Long-term outcomes from a population-based cohort. Surgery. 2021.
- 26. Diamantopoulos LN, Sekar RR, Holt SK, et al. Patterns and timing of perioperative blood transfusion and association with outcomes after radical cystectomy. Urol Oncol. 2021.
- 27. Khuri SF, Henderson WG, DePalma RG, et al. Determinants of long-term survival after major surgery and the adverse effect of postoperative complications. Ann Surg. 2005;242:326-41; discussion 41-3.
- 28. Deng C, Bellomo R, Myles P. Systematic review and meta-analysis of the perioperative use of vasoactive drugs on postoperative outcomes after major abdominal surgery. Br J Anaesth. 2020;124:513-24.
- 29. Li Y, Li H, Zhang D. Timing of norepinephrine initiation in patients with septic shock: a systematic review and meta-analysis. Crit Care. 2020;24:488.
- 30. Mizota T, Dong L, Takeda C, et al. Invasive Respiratory or Vasopressor Support and/or Death as a Proposed Composite Outcome Measure for Perioperative Care Research. Anesth Analg. 2019;129:679-85.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Research |
| Authors | |
| Project Number | Project no: KA20 /72 |
| Publication Date | June 30, 2022 |
| Acceptance Date | March 31, 2022 |
| Published in Issue | Year 2022 Volume: 47 Issue: 2 |
