PMID- 30336947
OWN - NLM
STAT- MEDLINE
DCOM- 20190123
LR  - 20190123
IS  - 1095-6859 (Electronic)
IS  - 0090-8258 (Linking)
VI  - 151
IP  - 3
DP  - 2018 Dec
TI  - A prospective trial of acute normovolemic hemodilution in patients undergoing
      primary cytoreductive surgery for advanced ovarian cancer.
PG  - 433-437
LID - S0090-8258(18)31285-X [pii]
LID - 10.1016/j.ygyno.2018.10.006 [doi]
AB  - OBJECTIVES: Our objective was to determine the safety and efficacy of acute
      normovolemic hemodilution (ANH) to reduce the requirement for allogenic red blood
      cell (RBC) transfusions in patients undergoing primary cytoreduction for advanced
      ovarian cancer. METHODS: Patients undergoing primary cytoreduction for advanced
      ovarian cancer were enrolled in a prospective trial assessing ANH at time of
      surgery. Intraoperative blood withdrawal was performed to a target hemoglobin of 
      8.0g/dL. A standardized transfusion protocol first using autologous then
      allogenic blood was applied intraoperatively and throughout hospitalization
      according to institutional guidelines. The primary endpoint was to determine the 
      overall rate of allogenic RBC transfusions in the intra- and postoperative
      periods. A predetermined allogenic RBC transfusion rate <35% was deemed a
      meaningful reduction from a 50% transfusion rate in historical controls. RESULTS:
      Forty-one patients consented to participate. Median blood withdrawn during ANH
      was 1650mL (range, 700-3000). Cytoreductive outcomes were as follows: 0mm, 30
      (73%); 1-10mm, 8 (20%); and >10mm, 3 (7%) residual disease. Estimated blood loss 
      was 1000mL (range, 150-2700). Fourteen patients (34%) received allogenic RBC
      transfusions intra- or postoperatively, meeting the primary endpoint. No patients
      were transfused outside protocol guidelines. The rate of >/=grade 3 complications
      (20%) and anastomotic leaks (7%) were similar to historical controls and met
      predefined safety thresholds. CONCLUSIONS: For patients with advanced ovarian
      cancer undergoing primary cytoreductive surgery, ANH appears to reduce allogenic 
      RBC transfusion rates versus historical controls without increasing perioperative
      complications. Further evaluation of the technique is warranted.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Tanner, Edward J
AU  - Tanner EJ
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America. Electronic address:
      etanner4@jhmi.edu.
FAU - Filippova, Olga T
AU  - Filippova OT
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America.
FAU - Gardner, Ginger J
AU  - Gardner GJ
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America; Department of Obstetrics and
      Gynecology, Weill Cornell Medical College, New York, NY, United States of
      America.
FAU - Long Roche, Kara C
AU  - Long Roche KC
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America; Department of Obstetrics and
      Gynecology, Weill Cornell Medical College, New York, NY, United States of
      America.
FAU - Sonoda, Yukio
AU  - Sonoda Y
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America; Department of Obstetrics and
      Gynecology, Weill Cornell Medical College, New York, NY, United States of
      America.
FAU - Zivanovic, Oliver
AU  - Zivanovic O
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America; Department of Obstetrics and
      Gynecology, Weill Cornell Medical College, New York, NY, United States of
      America.
FAU - Fischer, Mary
AU  - Fischer M
AD  - Department of Anesthesia, Memorial Sloan Kettering Cancer Center, New York, NY,
      United States of America.
FAU - Chi, Dennis S
AU  - Chi DS
AD  - Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer
      Center, New York, NY, United States of America; Department of Obstetrics and
      Gynecology, Weill Cornell Medical College, New York, NY, United States of
      America.
LA  - eng
GR  - P30 CA008748/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20181016
PL  - United States
TA  - Gynecol Oncol
JT  - Gynecologic oncology
JID - 0365304
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Cytoreduction Surgical Procedures/*methods
MH  - Female
MH  - Hemodilution/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Ovarian Neoplasms/pathology/*surgery
MH  - Prospective Studies
MH  - Young Adult
OTO - NOTNLM
OT  - *Acute normovolemic hemodilution
OT  - *Blood transfusion
OT  - *Ovarian cancer
OT  - *Primary cytoreduction
OT  - *Prospective trial
OT  - *Surgery
EDAT- 2018/10/20 06:00
MHDA- 2019/01/24 06:00
CRDT- 2018/10/20 06:00
PHST- 2018/07/18 00:00 [received]
PHST- 2018/09/26 00:00 [revised]
PHST- 2018/10/02 00:00 [accepted]
PHST- 2018/10/20 06:00 [pubmed]
PHST- 2019/01/24 06:00 [medline]
PHST- 2018/10/20 06:00 [entrez]
AID - S0090-8258(18)31285-X [pii]
AID - 10.1016/j.ygyno.2018.10.006 [doi]
PST - ppublish
SO  - Gynecol Oncol. 2018 Dec;151(3):433-437. doi: 10.1016/j.ygyno.2018.10.006. Epub
      2018 Oct 16.