Abstract: PD73-08
Sources of Funding: none

Introduction

The effects of perioperative blood transfusion (PBT) on morbidity, mortality following cancer surgery have previously been demonstrated in several malignancies including renal cell carcinoma (RCC). However, the significance of transfusion timing is still unclear. The purpose of this study is to evaluate whether intraoperative BT (InBT) differ from postoperative BT (PoBT) in regards to oncological outcomes in patients treated with nephrectomy for RCC.

Methods

Study included 1159 patients with RCC who underwent radical (RN) or partial nephrectomy (PN) between 1988 and 2013. PBT was defined as receipt of packed red blood cells either during surgery or during the postsurgical hospitalization. Univariate and multivariate models were used to evaluate the association of BT with cancer-specific survival (CSS), disease-free survival (DFS) and overall survival (OS).

Results

Of 1159 patients undergoing nephrectomy, 198 patients (17.1%) received a PBT. Patients were next divided into 3 groups; no PBT, InBT alone (n=117) and PoBT alone (n=60). Twenty one patients of the PBT group (10.6%) received both intra and post-operative transfusion. Given the small number of patients, this sub-group was excluded. On multivariate analyses, receipt of InBT was associated with significantly increased risk of local disease recurrence (HR: 2.3; P=0.025), metastatic progression (HR: 2.2; P=0.006), cancer- specific mortality (HR: 2.95; P=0.009) and all-cause mortality (HR: 2.05; P=0.007); while receipt of a PoBT did not independently bear an increased risk of local recurrence (p = 0.1), metastatic progression (P=0.095) or kidney cancer death (P=0.53), yet did significantly increase the risk of overall mortality (HR: 2.6; P=0.002).

Conclusions

In the current cohort, InBT but not PoBT was associated with significantly increased risk of cancer recurrence and cancer-specific mortality._x000D_ This observation requires further studies to assess the impact and management of more restrictive intraoperative blood management strategies._x000D_

Funding

none