The impact of a bloodless medicine program on pancreatic resections: A single-institution experience incorporating patients with borderline-resectable and locally advanced pancreatic cancer

BackgroundPatients undergoing pancreatic resection patients who decline blood transfusion represent a clinical challenge. While bloodless medicine programs are valuable, their impact remains unclear, especially for those with borderline-resectable and locally advanced pancreatic ductal adenocarcinoma (PDAC).MethodsRetrospective review of institutional databases identified patients who did not accept blood transfusion and underwent pancreatic resection from 2013-2022. We collated hemoglobin values, interventions to minimize symptomatic anemia, and patient outcomes.ResultsThirteen patients were identified. Median age was 63 years (range: 52-75 years) and eight (61.5%) were female. All procedures were performed electively for invasive malignancy with PDAC as the most common diagnosis (11/13; 84.6%) and pancreaticoduodenectomy as the most common procedure (11/13; 84.6%). Vascular involvement was common in the 11 patients with PDAC (borderline-resectable: 7/11; 63.6% and locally advanced: 3/11; 27.3%), as was the use of multi-agent chemotherapy (n=10) and preoperative radiotherapy (n=8) prior to surgery. Median blood loss was 400 mL (range: 100-2200 mL). Intraoperative measures included acute normovolemic hemodilution in one patient and red blood cell salvage in three patients. Median preoperative hemoglobin was 12.3 g/dL (range: 10.3-14.2 g/dL) and median nadir hemoglobin was 9.2 g/dL (range: 5.2-11.8 g/dL). Median hospital stay was 10 days (range: 6-42 days). Thirty-day mortality was 0% and one-year overall survival was 69.2% with median follow-up of 26.4 months.ConclusionPancreatic resections can be performed safely in patients who decline blood transfusion, even with borderline-resectable and locally advanced PDAC. Avoiding transfusions and employing blood-conservation techniques does not appear to detrimentally impact survival.