The blood-saving effect of vasopressinergic V1 receptor agonists in urologic oncology

Objective: to investigate whether it is expedient to use the selective vasopressinergic V1 receptor agonist Remestyp® (terlipressin) to reduce the amount of blood loss and the duration of urologic cancer surgery.

Materials and methods. Remestyp® was used as a selective vasopressor. The fact that the drugs in this group can be used in cancer surgery is due to their ability to induce pronounced vasospasm of the microvasculature of the parenchymal organs, by considerably reducing blood flow in the latter, which, by taking into account the abundant vascularization of tumor tissue with numerous arteriovenous anastomoses, allows more optimal surgical conditions to be created. At the same time, it should be noted that selective vasopressors do not enhance blood cell aggregation, which is especially important for urologic cancer patients who are often at an increased thrombosis risk due to the presence of comorbidity, advanced age and surgical duration. The retrospective and prospective studies enrolled 54 patients operated on for urologic cancer in the period from 2014 to 2015.

Results. Analysis of the results of the studies showed that the use of the drug from the group of vasopressinergic V1 receptor agonists resulted in decreased intraoperative blood loss in patients and contributed to a shorter surgical treatment duration.

Conclusion. The findings suggest that it is expedient to use selective vasopressors for surgical treatment quality improvement in urologic oncology.

1. Злокачественные новообразования в России в 2015 году (заболеваемость и смертность). Под ред. А. Д. Каприна, В. В. Старинского, Г. В. Петровой. М.: МНИОИ им. П. А. Герцена – филиал ФГБУ «НМИРЦ» Минздрава России, 2017. 250 с. [Malignant tumors in Russia in 2015 (morbidity and fatality). Eds.: А. D. Kaprin, V. V. Starinskiy, G. V. Petrova. Moscow: MNIOI im. P. A. Gertsena – filial FGBU “NMIRTS” Minzdrava Rossii, 2017. 250 p. (In Russ.)].

2. Darenkov S. P., Kotov S. V., Proskokov A. A. et al. Importance of surgery of quick recovery program for surgical treatment of bladder tumors. Urologiia 2015;(6):109–15. PMID: 28247690.

3. Yoshiyama A., Morii T., Susa M. et al. Preoperative evaluation of renal cell carcinoma patients with bone metastases on risks for blood loss, performance status and lethal event. J Orthop Sci 2017; S0949–2658(17):30183–5. DOI: 10.1016/j.jos.2017.07.006. PMID: 28784566.

4. Fardoun T., Chaste D., Oger E. et al. Predictive factors of hemorrhagic complications after partial nephrectomy. Eur J Surg Oncol 2014;40(1):85–9. DOI: 10.1016/j.ejso.2013.11.006. PMID: 24268762.

5. Goodnough L. T. Blood management: transfusion medicine comes of age. Lancet 2013;381(9880):1791–2. DOI: 10.1016/S0140–6736(13)60673-X. PMID: 23706789.

6. Resar L. M., Frank S. M. Bloodless medicine: what to do when you can’t transfuse. Hematology Am Soc Hematol Educ Program 2014;2014(1):553–8. DOI: 10.1182/asheducation-2014.1.553. PMID: 25696910.

7. Elemary M., Seghatchian J., Stakiw J. et al. Transfusion challenges in hematology oncology and hematopoietic stem cell transplant – literature review and local experience. Transfus Apher Sci 2017;56(3):317–21. DOI: 10.1016/j.transci.2017.05.022. PMID: 28642120.

8. Resar L. M., Wick E. C., Almasri T. N. et al. Bloodless medicine: current strategies and emerging treatment paradigms. Transfusion 2016;56(10):2637–47. DOI: 10.1111/trf.13736. PMID: 27473810.

9. Wang C., Han J., Xiao L., et al. Efficacy of vasopressin/terlipressin and somatostatin/octreotide for the prevention of early variceal rebleeding after the initial control of bleeding: a systematic review and metaanalysis. Hepatol Int 2015;9(1):120–9. DOI: 10.1007/s12072-014-9594-9. PMID: 25788386.

10. Ida K. K., Otsuki D. A., Sasaki A. T. et al. Effects of terlipressin as early treatment for protection of brain in a model of haemorrhagic shock. Crit Care 2015; 19:107. DOI: 10.1186/s13054-015-0825-9. PMID: 25888229.

11. Bhutta A. Q., Garcia-Tsao G. The role of medical therapy for variceal bleeding. Gastrointest Endosc Clin N Am 2015;25(3):479–90. DOI: 10.1016/j.giec.2015.03.001. PMID: 26142033.

12. Chen Z., Zhou P., Lu Y., Yang C. Comparison of effect of norepinephrine and terlipressin on patients with ARDS combined with septic shock: a prospective single-blind randomized controlled trial. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue 2017;29(2):111–6. DOI: 10.3760/cma.j.issn.2095–4352.2017.02.004. PMID: 28625256.

13. Park K. S., Yoo K. Y. Role of vasopressin in current anesthetic practice. Korean J Anesthesiol 2017;70(3):245–57. DOI: 10.4097/kjae.2017.70.3.245. PMID: 28580075.

14. Пылаева Н. Ю., Йовбак В. М., Жданюк Л. А. и др. Кровосберегающий эффект агонистов V1-вазопрессиновых рецепторов при операциях на магистральных артериях нижних конечностей. Материалы XXX Международной конференции «Новые направления в лечении сосудистых больных», Сочи, 25–27 июня 2015. С. 506–507. [Pylaeva N. Yu., Yovbak V. M., Zhdanyuk L. A. et al. The blood-saving effect of agonists of V1- vasopressin receptors in operations on the main arteries of the lower limbs. Materials of the XXX International Conference «New Directions in the Treatment of Vascular Patients», Sochi, June 25–27, 2015. Pp. 506–507. (In Russ.)].