Perioperative blood transfusion in ovarian cancer patients with post neoadjuvant chemotherapy and interval cytoreduction surgery

Abstract

Author(s): Adarsh Dharmarajan, Mohandoss Murugesan, Merline Augustine, Riyas Malodan, Sangeetha K Nayanar

Introduction: The adoption of Neoadjuvant Chemotherapy (NACT) preceding Interval Cytoreductive Surgery (ICS) has become increasingly favoured in the management of ovarian cancer. Nevertheless, in the context of NACT, more than 50% of patients experience grade 3-4 anaemia as a result of myelosuppressive chemotherapy, thereby elevating the perioperative risk for blood transfusion. The main goal was to assess the incidence of Perioperative Blood Transfusion (PBT) in ovarian cancer patients undergoing ICS following NACT. The secondary objective involved examining the impact of perioperative blood transfusion on Disease-Free Survival (DFS) in these individuals.

Methods: Retrospective study, clinical and transfusion details on ovarian cancer patients who underwent NACT followed by ICS was captured. The outcome of interest was administration of RBC transfusions to the patients during the perioperative period. DFS was expressed in Kaplan Meier plot and compared based on PBT risk using log rank test.

Results: A total of 69 patients were included in analysis, with median age of 52 (32 to 68) years. Baseline Haemoglobin (Hb) and preoperative Hb was 11.6 g/dL and 10.7 g/dL. CA 125 at baseline and before surgery was 1545 and 52 units/mL. Median surgery duration was 3.5 hours and blood loss were 500 (100 ml to 2500 ml). 37 (54%) patients received PBT with units ranging from 0 to 5 RBC units. The DFS in patients with PBT was lower than patients without transfusion, but without statistical significance (16 vs. 21 months, p=0.618).

Conclusion: PBT was observed in 54% of ca ovary patients who underwent NACT and ICS. Patients exposed to PBT experienced a decrease in DFS compared to those without PBT, although this difference was not statistically significant.

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