Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2023 Jun;63(6):1129-1140.
doi: 10.1111/trf.17367. Epub 2023 Apr 27.

Postoperative transfusion hemoglobin threshold and functional recovery after high-risk oncologic surgery: A randomized controlled pilot study

Xavier Chapalain  1 , Sigismond Lasocki  2 , Thomas Gargadennec  1 , Maëlys Consigny  3 , Maeva Campfort  2 , Anna Cadic  1 , Maxime Léger  2 , Patricia Dias  3 , Catherine Le Niger  4 , Rosemary L Sparrow  5 , Olivier Huet  1 , Cécile Aubron  5   6
Affiliations
Randomized Controlled Trial

Postoperative transfusion hemoglobin threshold and functional recovery after high-risk oncologic surgery: A randomized controlled pilot study

Xavier Chapalain et al. Transfusion. 2023 Jun.

Abstract

Background: Robust evidence to inform best transfusion management after major oncologic surgery, where postoperative recovery might impact treatment regimens for cancer, is lacking. We conducted a study to validate the feasibility of a larger trial comparing liberal versus restrictive red blood cells (RBC) transfusion strategies after major oncologic surgery.

Study design and methods: This was a two-center, randomized, controlled, study of patients admitted to the intensive care unit after major oncologic surgery. Patients whose hemoglobin level dropped below 9.5 g/dL, were randomly assigned to immediately receive a 1-unit RBC transfusion (liberal) or delayed until the hemoglobin level dropped below 7.5 g/dL (restrictive). The primary outcome was the median hemoglobin level between randomization to day 30 post-surgery. Disability-free survival was evaluated by the WHODAS 2.0 questionnaire.

Results: 30 patients were randomized (15 patients/group) in 15 months with a mean recruitment rate of 1.8 patients per month. The median hemoglobin level was significantly higher in the liberal group than in the restrictive group: 10.1 g/dL (IQR 9.6-10.5) versus 8.8 g/dL (IQR 8.3-9.4), p < .001, and RBC transfusion rates were 100% versus 66.7%, p = .04. The disability-free survival was similar between groups: 26.7% versus 20%, p = 1.

Discussion: Our results support the feasibility of a phase 3 randomized controlled trial comparing the impact of liberal versus restrictive transfusion strategies on the functional recovery of critically ill patients following major oncologic surgery.

Keywords: critically ill patients; functional recovery; hemoglobin threshold; oncologic surgery; pilot study; red blood cells transfusion.

PubMed Disclaimer

References

REFERENCES

    1. Ludwig H, Van Belle S, Barrett-Lee P, Birgegård G, Bokemeyer C, Gascón P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer. 2004;40(15):2293-306.
    1. Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004;5(116 Suppl 7A):11S-26S.
    1. van de Pol SMG, Doornaert PAH, de Bree R, Leemans CR, Slotman BJ, Langendijk JA. The significance of anemia in squamous cell head and neck cancer treated with surgery and postoperative radiotherapy. Oral Oncol. 2006;42(2):131-8.
    1. Adams A, Scheckel B, Habsaoui A, Haque M, Kuhr K, Monsef I, et al. Intravenous iron versus oral iron versus no iron with or without erythropoiesis- stimulating agents (ESA) for cancer patients with anaemia: a systematic review and network meta-analysis. Cochrane Database Syst Rev. 2022. Cochrane Haematology Group, Editor Cochrane Database of Systematic Reviews [Internet] 2022 Jun 20 [cited 2022 Dec 12];2022(6). Available from. 2022 CD012633. https://doi.org/10.1002/14651858.CD012633.pub2
    1. Ecker BL, Simmons KD, Zaheer S, Poe SLC, Bartlett EK, Drebin JA, et al. Blood transfusion in major abdominal surgery for malignant tumors: a trend analysis using the National Surgical Quality Improvement Program. JAMA Surg. 2016;151(6):518-25.

Publication types

LinkOut - more resources