Survival outcomes of acute normovolemic hemodilution in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center Team Ovary study

Thomas Boerner, Edward Tanner, Olga Filippova, Qin C. Zhou, Alexia Iasonos, William P. Tew, Roisin E. O'Cearbhaill, Rachel N. Grisham, Ginger J. Gardner, Yukio Sonoda, Nadeem R. Abu-Rustum, Oliver Zivanovic, Kara Long Roche, Anoushka M. Afonso, Mary Fischer, Dennis S. Chi*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To describe oncologic outcomes after using acute normovolemic hemodilution (ANH) to reduce requirement for allogenic red blood cell transfusions (ABT) in patients undergoing primary debulking surgery (PDS) for advanced ovarian cancer. Methods: We performed a post-hoc analysis of a recent prospective trial investigating the safety and feasibility of ANH during PDS for advanced ovarian cancer. We report long-term survival outcomes. We compared demographics, clinicopathological characteristics, survival outcomes in this cohort of Stage IIIB-IVB high-grade serous ovarian cancer patients undergoing ANH (ANH group), with a retrospective cohort of all other patients (standard group) undergoing PDS during the same time period (01/2012–04/2017). Standard statistical tests were used. Results: There were no demographic or clinicopathological differences between ANH (n = 33) and standard groups (n = 360), except for higher median age at diagnosis (57 vs. 62 years, respectively; p = 0.044) and shorter operative time (357 vs. 446 min, respectively; p < 0.001) in the standard group. Cytoreductive outcomes (ANH vs. standard): 0 mm, 69.7 vs. 63.9%; gross residual disease (RD) ≤1 cm, 21.2 vs. 26.9%; >1 cm, 9.1 vs. 9.2% (p = 0.78). RD after PDS was the only independent factor associated with worse progression-free survival (PFS) on multivariable analysis (p < 0.001). Patients with BRCA mutations trended towards improved PFS (p = 0.057). Significant factors for overall survival (OS) on multivariable analysis: preoperative CA125 (p = 0.004), ascites (p = 0.018), RD after PDS (p = 0.04), BRCA mutation status (p < 0.001). After adjustment for potential confounders, ANH was not independently associated with PFS or OS [PFS: HR 0.928 (0.618–1.395); p = 0.721; OS: HR 0.588 (95%CI: 0.317–1.092); p = 0.093]. Conclusions: ANH is an innovative approach in intraoperative management. It was previously proven to decrease need for ABT while maintaining the ability to achieve complete gross resection and associated benefits.

Original languageEnglish (US)
Pages (from-to)51-55
Number of pages5
JournalGynecologic oncology
Volume160
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Acute normovolemic hemodilution
  • Allogenic blood transfusion
  • Cytoreductive surgery
  • Ovarian cancer
  • Primary debulking surgery

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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