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PLASTIC RECONSTRUCTIVE AND REGENERATIVE SURGERY

Original article

Blood Transfusion - 2 2022 (March-April)

Peri-operative blood management of Jehovah’s Witnesses undergoing cytoreductive surgery for advanced ovarian cancer

Authors

Innocenza Palaia , Giuseppe Caruso , Violante Di Donato , Giorgia Perniola , Giancarlo Ferrazza , Enrico Panzini , Maria Scudo , Anna Di Pinto , Ludovico Muzii , Pierluigi Benedetti Panici

Key words: bloodless surgery, ferric carboxymaltose, Jehovah’s Witnesses, ovarian cancer, perioperative blood management
Doi: 10.2450/2021.0416-20
Publication Date: 2021-02-25

Abstract

Background - The aim of this study was to evaluate the efficacy and feasibility of a peri-operative bloodless medicine and surgery (BMS) protocol in reducing severe post-operative anaemia (haemoglobin [Hb] <7 g/dL) in Jehovah’s Witnesses undergoing cytoreductive surgery for advanced epithelial ovarian cancer.
Materials and methods - This was a single-institution retrospective study enrolling Jehovah’s Witnesses who underwent elective bloodless surgery for advanced epithelial ovarian cancer between October 2017 and April 2020. All patients followed a standardised bloodless medicine and surgery protocol based on ferric carboxymaltose and erythropoietin if indicated.
Results - Twenty-five patients with a mean age of 61.7 years (range, 35-80) were enrolled. Pre-operatively, ten patients (40%) were mildly anaemic (mean Hb of 10.2 g/dL [range, 9.2-11.4]) and received ferric carboxymaltose. Only four (16%) patients had severe anaemia after surgery (mean Hb of 6.1 g/dL [range, 4.1-6.9]) and received ferric carboxymaltose and erythropoietin. Compared to patients with a post-operative Hb ≥7 g/dL, those with Hb <7 g/dL had higher mean body mass index (25.8±1.8 vs 30.7±1.8 kg/m2; p<0.001), mean baseline CA125 (236.1±184.5 vs 783.7±273.5 IU/mL; p<0.001), median surgical complexity score (2 vs 10; p<0.001), and rate of post-operative complications (14.3 vs 100%; p<0.001). Moreover, these patients had a longer mean operating time (3.4±0.6 vs 5.5±0.4 h; p<0.001), duration of stay in hospital (5.5±0.7 vs 24.0±9.8 days; p<0.001), and time to adjuvant chemotherapy  (27.2±2.6 vs 65.3±13.4 days; p<0.001).
Discussion - The use of a multidisciplinary bloodless medicine and surgery protocol is safe and effective in reducing the rate of severe post-operative anaemia and improving surgical and oncological outcomes of Jehovah’s Witnesses with advanced epithelial ovarian cancer. Further large-scale, prospective studies are required to confirm these data.

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Authors

Innocenza Palaia Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giuseppe Caruso Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Violante Di Donato Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giorgia Perniola Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Giancarlo Ferrazza Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Enrico Panzini Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Maria Scudo Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Anna Di Pinto Department of Immunohaematology and Transfusion Medicine, Sapienza University, Policlinico Umberto I, Rome, Italy

Ludovico Muzii Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

Pierluigi Benedetti Panici Department of Maternal and Child Health and Urological Sciences, Sapienza University, Policlinico Umberto I, Rome, Italy

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