A Slow March Toward Eliminating Transfusion in Uro-Oncology
Mené sur 353 patients atteints d'un cancer de la vessie (âge médian : 69 ans ; 74,5 % d'hommes), cet essai randomisé multicentrique évalue l'intérêt, pour réduire le nombre de transfusions sanguines, d'une administration d'acide tranexamique (TXA) avant et pendant une cystectomie radicale par voie ouverte
Radical cystectomy (RC) is a standard treatment for patients with bladder cancer. Despite decades of refinement in surgical technique, most patients undergoing RC will experience a surgical complication. Excessive surgical blood loss is common during RC. Surgical blood loss increases cardiopulmonary stress and fluid imbalances, which are particularly challenging in the typical patient undergoing RC who is older (age >65) with multiple comorbidities. Blood transfusion also poses systemic challenges due to the scarcity of blood products.The most widely adopted measure to reduce blood loss and transfusion requirements during RC is robot-assisted radical cystectomy (RARC). Multiple randomized clinical trials have demonstrated lower blood loss and transfusion requirement with RARC compared with open RC. Additionally, RARC may reduce postoperative pain, shorten hospital stay, and minimize wound complications. Adoption of RARC is increasing, and it may become the dominant approach to RC in the US within the next decade. Regardless of these clinical trial results, many experienced surgeons continue to achieve low transfusion rates and excellent outcomes with open RC, ensuring that both approaches will always have a place in uro-oncology. Randomized clinical trials also indicate that vessel ligation with a stapler or LigaSure (Medtronic) or intraoperative vasopressor use can lower surgical blood loss.
JAMA Surgery , éditorial, 2023