Transfusion utilization during adnexal or peritoneal cancer surgery: effects on symptomatic venous thromboembolism and survival.
OBJECTIVE
To determine whether perioperative packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusions during ovarian, tubal, or peritoneal cancer surgery increase the risk of symptomatic postoperative venous thromboembolism (VTE) and adversely affect overall survival.


METHODS
We conducted a retrospective review of all cases of surgical exploration for resection of stage IIIC-IV adnexal/peritoneal cancer between November 1998 and May 2002 at Memorial Sloan-Kettering Cancer Center. Patients with a history of prior or active preoperative VTE were excluded. Routine intraoperative and postoperative VTE prophylaxis including lower extremity external pneumatic compression with or without postoperative subcutaneous heparin was utilized in all cases. Symptomatic postoperative VTE was diagnosed by lower extremity Doppler or computerized tomography (excluding cases with only ovarian vein thrombosis). Clinical parameters were examined by a logistic regression analysis to identify independent prognostic predictors of postoperative symptomatic VTE, which occurred within 30 days of surgery. Survival was calculated using the Kaplan-Meier method.


RESULTS
In all, 174 patients underwent exploratory surgery, and 6 (3.4%) were excluded due to active or prior history of VTE. Of the remaining 168 patients, 71 (42%) received at least one perioperative transfusion of PRBC or FFP. Postoperative VTE was documented in 5 of 46 (11%) patients who received a postoperative transfusion compared to 3 of 122 (2.5%) patients who did not (P = 0.04; odds ratio, 4.8); moreover, VTE was noted in 3:16 (19%) patients who received postoperative FFP compared to 5:152 (3.3%) patients who did not (P = 0.01, odds ratio of 6.78). Age, stage, body mass index, length of the operation, blood loss, presence of ascites, volume of ascites, residual disease status, preoperative hemoglobin level and coagulation profile were not associated with increased risk for VTE. When survival results were stratified by transfusion utilization and controlling for optimal debulking status, perioperative transfusions had no apparent effect on overall survival.


CONCLUSIONS
In women with stage IIIC-V disease, postoperative blood product transfusions particularly FFP were associated with increased risk of DVT and PE, but transfusions had no impact on overall survival.
Abu-Rustum
Nadeem R
NR
Department of Surgery, Gynecology Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, Room C-1096, New York, NY 10021, USA. abu-rusn@mskcc.org
Richard
Scott
S
Wilton
Andrew
A
Lev
Gali
G
Sonoda
Yukio
Y
Hensley
Martee L
ML
Gemignani
Mary
M
Barakat
Richard R
RR
Chi
Dennis S
DS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005185:Fallopian Tube Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care / Q000009:adverse effects; D010534:Peritoneal Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D010949:Plasma; D012189:Retrospective Studies; D013923:Thromboembolism / Q000209:etiology*; D065227:Transfusion Reaction; D020246:Venous Thrombosis / Q000209:etiology*