Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer

Abstract

Background/Aims: Gastrectomy with systemic lymphadenectomy sometimes causes excessive bleeding even by experienced surgeons. The aim of this study was to evaluate how intraoperative estimated blood loss (EBL) affected the long-term outcomes after curative surgery of patients with stage II/III gastric cancer (GC). Methods: This study included 203 patients with stage II/III GC who did not receive perioperative blood transfusion between 1999 and 2015. The optimal cutoff and the prognostic significance of EBL were determined retrospectively. Results: The median EBL was 285 ml. Receiver operating characteristic curve analysis identified 400 ml as an optimal cutoff. Patients with EBL ≥400 ml were more likely to have hepatic relapse and worse prognosis compared to those with EBL <400 ml. EBL ≥400 ml was identified as an independent prognostic factor for mortality by multivariable analysis. When patients were subdivided according to administration of adjuvant chemotherapy, there was a significant difference between the EBL ≥400 and <400 ml groups in patients who underwent surgery alone, whereas the prognosis was similar for patients of both groups who received adjuvant chemotherapy. Conclusion: EBL serves as a useful predictor for risk stratification after curative gastrectomy in patients with stage II/III GC.

Estimated intraoperative blood loss correlates with postoperative cardiopulmonary complications and length of stay in patients undergoing video-assisted thoracoscopic lung cancer lobectomy: a retrospective cohort study

“…To our knowledge, the present study was the first to demonstrate the influence of EIBL on the risk of PCCs and length of stay following VATS lobectomy for operable NSCLC. Because the receipt of perioperative blood transfusion could exert the immunosuppressive effects and then worsen the surgical outcomes, we only included the patients who did not receive any perioperative blood transfusion to avoid potential confounding bias risks influencing the actual value of EIBL, as many investigators previously suggested [ 11 , 13 ]. In our series, a ROC analysis was employed to determine a threshold value of EIBL that had the discriminatory ability for the prediction of PCCs.…”

“…Secondly, evidence indicates that a larger volume of EIBL has the ability to directly cause the immune dysfunction and impair the nutritional status because of a significant loss of plasma constituents and leukocytes that engage in the anticancer immunity [ 13 ]. Angele et al [ 29 ] reviewed current experimental studies utilizing the models of trauma and hemorrhagic shock, which have defined the effects on the immune-inflammatory responses, and found that blood loss and surgical injury can suppress the cell-mediated immune responses through the depression of mitogenic response of T-lymphocytes, macrophage antigen presentation capacity and amounts of T-helper 1 lymphokines.…”

“…Therefore, an excessive EIBL with its induced events, such as the receipt of intraoperative and postoperative blood transfusion, has the potential to worsen patient outcomes after oncological surgery. Current evidence demonstrates that a large volume of EIBL and perioperative blood transfusion were strong prognostic factors for poor short-term and long-term survival in a variety of surgical specialties [ 11 – 13 ]. However, the impact of EIBL on PCCs complicating VATS lobectomy still remains unknown due to the scarcity of data regarding in-hospital outcomes in current evidence [ 11 , 14 ].…”

Randomized clinical trial of extensive intraoperative peritoneal lavage versus standard treatment for resectable advanced gastric cancer (CCOG 1102 trial)

“…Han and co‐workers reported that free cancer cells can be released intraperitoneally by improper handling of lymphovascular vessels of the stomach. In addition, some studies have reported that the amount of IBL was associated with tumour recurrence and poor outcome. Arita et al .…”

Robotic versus laparoscopic gastrectomy with D2 lymph node dissection for advanced gastric cancer: a propensity score-matched analysis

“…Intraoperative blood loss has been shown to be associated with prognosis of patients in gastric cancer. 39 , 40 Kamei et al reported that curative resection with lower blood loss can contribute to improved survival. 41 Moreover, the less intraoperative blood loss may promote postoperative recovery, especially for elderly patients.…”