Blood loss and the need for transfusion in patients who undergo partial orradical nephrectomy for renal cell carcinoma

Purpose: We assessed blood loss and subsequent transfusion associated with nephrectomy performed for suspected renal cell carcinoma to establish guide lines for preoperative autologous blood donation and identify a subgroup of patients that may benefit from erythropoietin administration. Materials and Methods: We retrospectively reviewed the charts of 211 patien ts who underwent partial (73%) or radical (23%) nephrectomy for presumed re nal cell carcinoma at our institution between 1990 and 1999. Patients were divided into groups 1-44.5% treated with radical nephrectomy for localized disease, 2-21.3% radical nephrectomy for metastatic lesions invading the re nal vasculature or inferior vena cava, 3-8% radical nephrectomy for metasta tic disease with locally extensive lesions and 4-26.5% partial nephrectomy for localized lesions. Patient charts were evaluated for preoperative and p ostoperative hematocrit, estimated blood loss, transfusions received, surgi cal complications and underlying disease. Results: Median estimated blood loss was 200, 400, 250 and 555 cc in groups 1 to 4, respectively. However, patients in groups 2 and 3 had a substantia lly greater range of blood loss than those in groups 1 and 4, respectively. The incidence of those with a blood loss of greater than 1 l. was 7%, 36%, 24% and 11% in groups 1, to 4, respectively. The incidence of those requir ing transfusion was significantly lower in group 1 than in groups 2 to 4 (1 8% versus 44%, 24% and 30%, respectively, p <0.009). Mean transfusion requi rement plus or minus standard deviation was significantly greater in groups 2 and 3 than in 1 and 4 (2.3 +/- 1.08, 5.5 +/- 4.4, 11.3 +/- 9.6 and 2.3 /- 1.7 units, respectively, p <0.05). No significant difference was noted i n the change in hematocrit as a result of surgery in the 4 groups (p >0.05) . Similarly underlying disease and operative complications did not have a s ignificant effect on blood loss or transfusion (p >0.05). Conclusions: Radical or partial nephrectomy for localized renal cell carcin oma leads to consistent and well tolerated operative blood loss that rarely results in the need for substantial transfusion. In contrast, nephrectomy for advanced disease may cause a risk of greater blood loss and subsequent need for the transfusion of multiple units of blood. While preoperative aut ologous blood donation may have limited value in this regard due to the hig h cost and number of units needed, preoperative erythropoietin administrati on may be a viable option. Prospective randomized studies are currently pla nned.