Abstract: PD36-07
Sources of Funding: none

Introduction

To determine the safety of a restrictive transfusion protocol (RTP) in patients radical cystectomy (RC) patients that are typically elderly with significant co-morbidity, given that perioperative blood transfusion (PBT) has been linked to poorer oncologic outcomes in this setting.

Methods

_x000D_ Outcomes for 173 consecutive patients meeting inclusion criteria undergoing RC for urothelial carcinoma (UC) from April 2010 to June 2014 by a single surgeon employing RTP were analyzed from an IRB approved, prospectively collected database.

Results

Outcomes for 173 consecutive patients meeting inclusion criteria undergoing RC for urothelial carcinoma (UC) from April 2010 to June 2014 by a single surgeon employing RTP were analyzed from an IRB approved, prospectively collected database. _x000D_ Results: Median follow-up was 3.1 years (range=0-5.1 years). Median age was 70 years (38-93). 46 patients (26.6%) received PBT. PBT patients had higher EBL (500 vs. 350, p=0.001), lower baseline hematocrit (28.9 vs. 33.3, p=0.005), and similar operative time (5.8 vs. 5.3 hours, p=0.01) and LOS (5.5 vs. 5, p=0.07). At discharge and 3 week follow-up there was no difference in hematocrit (p>0.05). In the no PBT group 90-day (65.6 vs. 86.7%, p=0.007) and high grade (15.6 vs. 34.8%, p=0.003) complication rates were lower. There were no differences in cardiac complication rates. On multivariable analysis predictors of PBT were age (OR=1.06, 95% CI [1.01, 1.11]), CCMI ?2 (OR=2.68, CI [1.09-7.04]), neoadjuvant chemotherapy (OR=3.74, CI [1.46, 10.19]), ?pT3 (OR=5.5, CI [2.33, 13.73]), baseline hematocrit (OR=0.95, CI [0.87, 1.00]) and EBL, although marginally (OR=1.001, CI [1, 1.003]). PBT was associated with lower RFS (HR=2.16, CI [1.13, 41.12], p=0.02) (Figure 1) and OS (HR=2.25, CI [1.25, 4.88], p=0.01)(Figure 2).

Conclusions

The use of RTP in RC is safe. PBT was associated with poorer RFS and OS independent of clinicopathologic characteristics.

Funding

none