PILOT STUDY IN OTTAWA
Surgery without transfusion
France Todd was leading a busy, healthy life when a routine test during a checkup led to a diagnosis of early-stage liver cancer.
“I never felt ill,” she said. “It was very fortunate I had the physical at the right time. It was just one of those fluke things.”
Before she had surgery to remove a four-centimetre tumour, the Ottawa human resources executive was asked if she would participate in a pilot study aimed at reducing the need for blood transfusions after liver surgery.
When she learned that nearly one-quarter of patients undergoing major liver surgery require a blood transfusion, Todd quickly agreed to participate.
“I don’t want to have one of those,” she told doctors. “If there is any way you can help me avoid having to get one, that would be great.”
Todd did avoid a blood transfusion as a result of the surgery. Now, researchers, led by Ottawa surgeon Dr. Guillaume Martel, are beginning a major study that could result in a similar outcome for liver patients around the world.
Martel, who is a surgeon at The Ottawa Hospital and associate professor at the University of Ottawa, and his team have been awarded nearly half a million dollars from the Canadian Institutes of Health Research to study a technique that involves removing about 10 per cent of a patient’s blood prior to liver surgery and replacing it after surgery.
Martel said the procedure — similar to donating blood — takes place once the patient is under anesthesia. The blood, which is stored in blood donation bags, is returned to the patient once the surgery is complete.
The procedure is believed to work by reducing blood pressure in the large veins leading to the liver, which means patients do not lose as much blood during surgery. Martel said it is a technique that has long been used successfully in some parts of the world, but for which there is virtually no research data.
The purpose of the Phase 3 randomized control trial, which will begin later this year, is to prove definitively whether the intervention works. Surgery, in general, is vastly under-investigated, he said.
“We spend a huge proportion of health-care dollars on surgery and traditionally it is not studied to the same degree or rigour as drugs would be. We need to be critical of what we do and take it to the next level.”
We spend a huge proportion of health-care dollars on surgery and traditionally it is not studied to the same degree or rigour as drugs would be.
The research is timely. The need for liver surgery, for a variety of reasons, is growing rapidly. The surgeries come with a significant (about one in four) risk of blood transfusion.
Transfusions save lives, notes Martel, but they can carry risks, including allergic reactions and heightened risk of complications. Emerging research has also raised the question of whether blood transfusions can increase the odds of cancer recurrence after cancer surgery, and blood is expensive for the health system and in limited supply, he said.
Martel’s team of researchers was one of 16 research groups from The Ottawa Hospital and the University of Ottawa awarded funding from the CIHR as part of its most recent project grant competition.
Other research includes investigating whether cell fragments from umbilical cord blood can treat acute kidney injury, research aimed at improving health among the homeless using e-cigarettes, and work aimed at harnessing the immune system to attack cancer.
In total, researchers affiliated with The Ottawa Hospital were awarded $12.7 million.