M. Khalili1, W. F. Morano1, L. Marconcini3, M. Sheikh1, M. Styler3, M. Zebrower2, W. Bowne1 1Drexel University College Of Medicine,Division Of Surgical Oncology/Department Of Surgery,Philadelphia, PA, USA 2Drexel University College Of Medicine,Division Of Anesthesia/Perioperative Medicine,Philadelphia, PA, USA 3Drexel University College Of Medicine,Division Of Hematology & Oncology/Department Of Medicine,Philadelphia, PA, USA
Introduction: Bloodless surgery is a multidisciplinary field that seeks to minimize blood
transfusions in surgical patients through a variety of perioperative hemoglobin optimizing
management strategies. Multidisciplinary techniques have been applied to various surgical
subspecialties with favorable outcomes. Bloodless pancreatic surgery (BPS) is a rarely
performed and understudied application of these protocols.
Methods: Literature search was performed on MEDLINE using MeSH terms "bloodless surgery"
or “Jehovah’s witness” and “pancreatectomy” or “pancreaticoduodenectomy,” published
between 2000 and 2017. We reviewed articles focused on BPS and searched references of
relevant articles. We examined implementation of reported preoperative, intraoperative and
postoperative transfusion reduction strategies. We report data regarding categorical variables as
proportions and data regarding quantitative continuous variables as medians with ranges.
Results: Fifteen patients requiring BPS are reported in the literature. We report an additional
three here (N=18). Surgical procedures involved distal pancreatectomy (n=5), radical antegrade
modular pancreaticosplenectomy (n=1), and pancreaticoduodenectomy (n=12). Specifically,
reported strategies fell into three categories: preoperative, intraoperative, and postoperative.
Preoperative strategies include treatment with erythropoietin (n=4), iron (n=4), vitamin B12
(n=1), and vitamin K (n=1). Intraoperative strategies include acute normovolemic hemodilution
(n=8) and cell saver (n=5). Postoperative strategies include treatment with erythropoietin (n=6)
and iron (n=6). Complications for the study cohort include bleeding (n=2), intra-abdominal
abscess (n=1), pancreatic leak (n=2), gastrojejunostomy stricture (n=1) and cardiopulmonary
issues (n=3). No mortalities were reported.
Conclusion: BPS is rarely performed, but feasible. Consultation requires a multidisciplinary
approach. Review of the literature reveals that no single bloodless strategy is used, while
combinations of strategies are employed based upon patient characteristics, multidisciplinary
practice, and surgeon/anesthesiologist preference. With careful patient blood management, BPS
can be performed with good outcomes.