Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer: Potential use of Perioperative Desmopressin to Reduce Allogenic Blood Transfusion Rates

Abstract

In the last decade, the correlation between cancer surgery outcome, disease recurrence, and patient survival with perioperative blood transfusion has been a topic of intense debate. In this regard, a large number of studies suggesting a direct link between perioperative blood transfusions and poorer prognosis in colorectal, liver, gastric, esophageal, and pancreatic cancers have been recently published.1–4 In the August issue of the Journal of Gastrointestinal Surgery, Saxena and colleagues conducted an elegant study assessing the impact of massive allogenic blood transfusion (MABT) on perioperative outcomes and overall survival in patients with peritoneal carcinomatosis undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).5 After critically reviewing more than 900 cases, the authors demonstrated that MABT is associated with an increased incidence of prolonged hospital stay, in-hospital mortality, and grade III/IV morbidity. Additionally, MABT was found to be an independent risk factor for reduced overall survival in patients with colorectal cancer peritoneal carcinomatosis (CRPC). Given that CRS/HIPEC is a long, complex, and aggressive multimodality surgical approach, nearly 25% of CRPC patients undergoing this procedure require MABT due to high volume blood loss. Besides emphasizing the detrimental impact on cancer surgery outcomes and survival, especially in colorectal cancer, authors highlight the urgent need to manage perioperative care from various aspects to minimize the rates of perioperative blood transfusions in CRS/HIPEC.