Invited Commentary <\/p>\n\n\n\n
October 2, 2024<\/p>\n\n\n\n
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.1<\/a><\/sup> 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.<\/a><\/p>\n\n\n\n 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.2<\/a><\/sup> 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.3<\/a><\/sup>,4<\/a><\/sup><\/a><\/p>\n\n\n\n In this issue of JAMA Surgery<\/em>, Breau and colleagues5<\/a><\/sup> present the findings of a randomized clinical trial that evaluated the effectiveness of tranexamic acid (TXA) in reducing blood loss during open RC. This multi-institutional study, conducted in Canada with 353 patients undergoing open RC, found that TXA did not reduce transfusion rate during RC. Both groups had a transfusion rate of 37%. Notably, TXA was not associated with a higher risk of complications, thromboembolic or otherwise. We commend Breau et al5<\/a><\/sup> for conducting a well-designed trial on an important topic. We believe these results are generalizable and that the uro-oncologist who performs open RC should avoid TXA.<\/a><\/p>\n\n\n\n Notwithstanding these results, TXA has been well documented to reduce transfusion requirements in other surgical settings.6<\/a><\/sup> It is unclear how the uro-oncologist should apply the data surrounding TXA when using a robotic approach to RC. Whether TXA is appropriate for use in other uro-oncologic surgeries with a high transfusion requirement and a high thromboembolism risk (eg, radical nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma7<\/a><\/sup>) is also unclear. As surgical techniques and supportive care evolve, the potential to significantly reduce transfusions in uro-oncologic procedures seems more achievable than ever.<\/p>\n","protected":false},"excerpt":{"rendered":" Invited Commentary October 2, 2024 A Sl […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26905"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=26905"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26905\/revisions"}],"predecessor-version":[{"id":26906,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/26905\/revisions\/26906"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=26905"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=26905"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=26905"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}