Association between Intraoperative Blood Transfusion, Regional Anesthesia and Outcome after Pediatric Tumor Surgery for Nephroblastoma

SIMPLE SUMMARY: Previously published data suggest anesthesiologic interventions during the perioperative period might play a major role in determining patient outcome after tumor surgery. However, only scarce data are available regarding this question in pediatric patients. This retrospective, multicenter study aimed to assess such a potential effect in pediatric patients undergoing cancer surgery for nephroblastoma. Data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival. The use of regional anesthesia or the choice of anesthetic had no effect. However, regional anesthesia was associated with fewer ICU transfers, a shortened hospital stay and a decreased postoperative neutrophil-to-lymphocyte ratio. The current study provides the first evidence for a possible association between anesthesia and outcome after pediatric cancer surgery. Children undergoing tumor surgery might therefore benefit from an optimized anesthetic regimen—including the use of regional anesthesia—and more restrictive blood transfusion management. ABSTRACT: Background: Recent data suggest that anesthesiologic interventions—e.g., the choice of the anesthetic regimen or the administration of blood products—might play a major role in determining outcome after tumor surgery. In contrast to adult patients, only limited data are available regarding the potential association of anesthesia and outcome in pediatric cancer patients. Methods: A retrospective multicenter study assessing data from pediatric patients (0–18 years of age) undergoing surgery for nephroblastoma between 2004 and 2018 was conducted at three academic centers in Europe. Overall and recurrence-free survival were the primary outcomes of the study and were evaluated for a potential impact of intraoperative administration of erythrocyte concentrates, the use of regional anesthesia and the choice of the anesthetic regimen. The length of stay on the intensive care unit, the time to hospital discharge after surgery and blood neutrophil-to-lymphocyte ratio were defined as secondary outcomes. Results: In total, data from 65 patients were analyzed. Intraoperative administration of erythrocyte concentrates was associated with a reduction in recurrence-free survival (hazard ratio (HR) 7.59, 95% confidence interval (CI) 1.36–42.2, p = 0.004), whereas overall survival (HR 5.37, 95% CI 0.42–68.4, p = 0.124) was not affected. The use of regional anesthesia and the choice of anesthetic used for maintenance of anesthesia did not demonstrate an effect on the primary outcomes. It was, however, associated with fewer ICU transfers, a shortened time to discharge and a decreased postoperative neutrophil-to-lymphocyte ratio. Conclusions: The current study provides the first evidence for a possible association between blood transfusion as well as anesthesiologic interventions and outcome after pediatric cancer surgery.