AUTOLOGOUS DONATION AND RADICAL PROSTATECTOMY 2109

23. Donahue, J. G., Muiioz, A, Ness, P. M., Brown, D. E., Jr., Yawn, D. H., McAUister, H. A., Jr., Reitz, B. A. and Nelson, K. E.: The declining risk of post-transfusion hepatitis C virus infection. New Engl. J. Med., 321: 369,1992.

EDITORIAL COMMENT

This excellent article analyzes a contemporary subject of great interestis autologous blood transfusion worth the cost? In this study, no patient who donated 2 units of his own blood required the transfusion of homologous blood and in nondononr the rate was 11%. Recognizing that transfusion practices today are safer than in the past, it is reasonable to ask whether this difference is worth the effort. I believe that it is and have been reluctant to alter my standard practice. Some patients just bleed more than you would like regardless of surgical technique. Furthermore, when performingrad- ical prostatectomy I am often willing to ‘spend” a little bit of blood in an effort to delineate the anatomy more carefully, widen the ~urgical margin or preserve the newvascular bundle. With the confidence that I have 3 units of autologous blood as a backup, I am able to emphasize the long-term success of the operation in terms of cancer control and quality of life rather than worrying about some bleeding that may accumulate to the point where a transfusion is necassary. Were this safety net not available, I do not believe that my results would be as good as they are. In an overzealous attempt to eliminate all bleeding, I believe that some urgeo on^ may interfere with nome of these long-term end pointa of E U ~ S S .

In addition, it is important to consider the peace of mind of the patient. Until all patients are convinced that transfusion practices are safe, they may worry more about the transfusion of a unit of blood than any other complication that could possibly occur during radical prostatectomy. In the 6nal analysis, increased uae of hemodi-

lution may achieve all of the advantages of autotramdim ‘on but a t a lower cost and at leea potential risk.’

Potrick C. Walsh

The Johns Hopkuur Hoapital

1. Nees, P. M., Bourke, D. L. and Walsh, P. D.: A randomized trial of perioperative hemodilution versus transfuero ’ n of preopera- tively deposited autologous blood in elective surgery. Transfu- sion, 32 226,1992.

Depamnent of uyk?Y Baltimore, Marylolul

REPLY BY AUTHORS The g w l of radical retropubic pmstateetomy is to remove all cancer

with pmrvation of normal urinarg and sexual function to the greatest extent possible. Theae g d a should not be compromised in an effort to avoid blood loss. the amount of blood lost during the operation, in our view, is not a p a l in itself but a byproduct of surgical technique baaed on anatomical dieeeetion. as so eloquently advocated in the Comment. Ae the data in our article show, there was no codat ion between preservation of neurovaecu- lar bundles and egtimated blood loss. Furthermore, the overall rate of positive surgical margh in this series was low (16% and only 8% in 1994l). We certainly agree that E U ~ removal of the cancer and preservation of quality of life are the most important pa ls ofthe operation. However, we believe that this can be done with a blood loss that seldom requires tmnsfum ‘on. Certainly, in a managed care environment the health benefita of autologous transfusl ’on would be difficult to justify by its cost.

1. Ohori. M., Wheeler, T. M., Kattan, M. W., Goto, Y. and Seardino, P. T.: Prognostic Significanca of @ve surgical margh in radical prostatectomy specimens. J. Urol., 1M: 1818,1995.

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