Blood loss and transfusion dynamics in renal cell carcinoma bone metastases surgery: Risk factors and survival...

This study aimed to identify predictors of intraoperative blood loss and survival outcomes in patients undergoing surgery for RCC bone metastases.

This retrospective study analyzed 27 patients treated for RCC bone metastases at a tertiary oncology center between 2013 and 2024. Demographic characteristics, tumor size and location, preoperative metrics, and intraoperative outcomes were reviewed. Blood loss was calculated using the Nadler formula and the Hb-balance method. Survival outcomes were assessed at 2 and 5 years postoperatively. Statistical analyses included t-tests, ANOVA, and linear regression, with significance set at p < 0.05.

The average intraoperative blood loss was 1632.62 mL ± 692.62, with 85.2 % of patients requiring transfusions. Older age (≥60 years; p = 0.039) and female sex (p = 0.008) were significantly associated with higher blood loss. Tumor size, anatomical location, pathologic fractures, and preoperative metrics-including platelet count, INR, and APTT-did not significantly impact blood loss. The median survival time was 31.67 months ± 38.5 (range 0-134 months), with preoperative hemoglobin < 115 g/L significantly associated with reduced 5-year (p = 0.013) and 2-year (p = 0.045) survival rates.

Older age and female gender notably indicate a higher risk of intraoperative blood loss, whereas preoperative hemoglobin levels are strong predictors of survival outcomes. Tumor size and location do not appear to affect blood loss significantly. These results highlight the importance of customized preoperative planning and the possible use of blood conservation techniques to reduce blood loss.