ASO Author Reflections: Evidence for Limiting Perioperative Allogenic Blood Transfusions for Patients Undergoing CRS/HIPEC

Excerpt

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is a complex oncologic intervention for patients with peritoneal carcinomatosis. Given the extensive nature of cytoreduction with multivisceral resection, peritonectomy, and exploration of multiple abdominal compartments, patients undergoing this procedure often require blood transfusion. It is critical to understand the impact of these transfusions on postoperative and long-term outcomes, given that current evidence in some tumors suggest a potential detrimental effect of perioperative blood transfusions.1,2 With regard to CRS/HIPEC, the data are mixed; however, there is a lack of high-quality studies to guide transfusion decisions for patients undergoing CRS/HIPEC. This may be due in part to the challenges of independently assessing the importance of a covariate such as blood transfusions, which may be influenced by a wide array of preclinical factors and also serve as a marker for other outcome-altering variables (i.e. tumor burden, preoperative hemoglobin, estimated blood loss). Propensity score matching is one statistical technique used to adjust for these confounders and yield a more reliable estimate of the independent effect of blood transfusions. Using a propensity-matched cohort from the US HIPEC Collaborative database, the goal of our study was to better describe the association between blood transfusions and postoperative outcomes after CRS/HIPEC, with further attention to the relationship between magnitude of transfusions and outcomes. …