Patient blood management in oncology in the Russian Federation: Resolution to improve oncology care.

There is accumulating evidence that anemia and iron deficiency, thrombocytopenia, blood loss and coagulopathy are independent risk factors for adverse patient outcomes in oncology and other settings. Patient blood management (PBM) aims to address these factors by managing and preserving a patient's blood. PBM improves patient health, but also reduces resource utilization, including use of allogeneic blood components, which is another risk factor for adverse outcomes. Supported by the World Health Organization and endorsed in WHA63.12, PBM is recommended by an increasing number of health authorities and is about to become a new standard of care. In support of the Russian National Long-Term Oncology Strategy 2030 to improve quality of oncological care, and with support from the National Association of Specialists in PBM, the PBM Oncology Working Group of the Russian Federation was created. In July 2020, this Group met to discuss the rationale and need for PBM in Russian oncology care. The Group recommended to include PBM as an integral part of standard oncology treatment pathways and developed a national resolution as a call to action on this matter, which was adopted in August 2020. This article details the rationale behind the resolution, delineates the action required from facilitating stakeholders (government; healthcare providers; educational facilities; research entities/institutions; funders; patient representatives/advocates), and proposes a roadmap for implementation. The generation of local health-economic and outcome data and the development of educational programs will be important in the implementation of PBM to help alleviate the health, social and economic burden of cancer.

Single-Center Experience of Surgical Treatment of Primary Retroperitoneal Tumors.

This study is an evaluation of surgical treatment results of primary retroperitoneal tumors. In Samara Regional Clinical Oncology Dispensary, from 2008 to 2015, the treatment of 187 patients (53 men and 134 women) was conducted. One hundred fifteen patients got tumor removal within the healthy tissue (R0), and 61 patients went through complete resection of tumor with wide margins (R0). Complete resection of tumor with wide margins (R0) with preoperative tumor vessel embolization was performed in 11 patients. According to the histological examination, malignant retroperitoneal tumor was detected in 85 patients (48.4%); in most cases it was presented by various forms of sarcoma. A benign tumor was diagnosed in 71 patients (40.3%), fibrolipomas (17.1%), and neurofibromas (12.5%). The diagnosis of 20 patients needs subsequent clarification, as mesenchymal tumor (6.2%) and histiocytoma (5.1%) were diagnosed. Short-term results of surgical treatment for the group, where complete resection of tumor with wide margins was performed: intraoperative blood loss 410.91 + - 113.31(ml), operation time 185.15 + -32.49(min); postoperative complications 10 (16,4%); mortality 3 (4,9%); LOS 23,14 ± 6,31; for removal of the tumor within healthy tissues: intraoperative blood loss 281.33 + -110.94 (ml), operation time 58.33 + -27.14(min) postoperative complications 7 (6,08%); mortality 2 (1,74%); LOS 6,98 ± 4,83; (t = 279, p = 0,015). For patients who went through preoperative tumor feeding vessel embolization, intraoperative blood loss was 121.33 ± 27.94 (ml), time of operation 43.13 ± 16.11 (min), postoperative complication 1 (4.5%), mortality 0 (0%), and length of stay 12.72 ± 1.49. After the complete resection of tumor with wide margins, intraoperative blood loss, operation time, the number of postoperative complications, and postoperative LOS were significantly greater in comparison with the group of patients where the tumor was removed within healthy tissues. The method of preoperative embolization of the tumor feeding vessels can reduce intraoperative blood loss, the time of operation, and the number of postoperative complications.