Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy

Hwang, Ho Kyoung; Jung, Myung Jae; Lee, Sung Hwan; Kang, Chang Moo; Lee, Woo Jung

doi:10.1002/jhbp.368

Cited by 18 publications

(10 citation statements)

References 41 publications

(43 reference statements)

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“…This is reflected by beneficial survival data for individual indications, which were also in good agreement with data in the literature: Jarnagin et al (intrahepatic and perihilar cholangiocarcinoma, 63 and 69% [ 17 ]; Zaydfudim et al (hepatocellular carcinoma, 6059 [ 18 ]; Schiergens et al and Margonis et al (CRLM 68% with transfusion and 82% without transfusion) [ 15 , 19 ]; esophageal cancer (40% with transfusion vs. 60% without transfusion) [ 20 ]; gastric cancer (82 vs. 60%) [ 16 ]; and pancreatic cancer (50 to 60% vs. 20%) [ 13 , 21 ]. Last not least, Mörner et al showed that anemia and transfusions were associated with adverse outcome [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

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BackgroundPatient Blood Management (PBM) is a systematic quality improving clinical model to reduce anemia and avoid transfusions in all kinds of clinical settings. Here, we investigated the potential of PBM in oncologic surgery and hypothesized that PBM improves 2-year overall survival (OS).MethodsRetrospective analysis of patients 2 years before and after PBM implementation. The primary endpoint was OS at 2 years after surgery. We identified a sample size of 824 to detect a 10% improvement in survival in the PBM group.ResultsThe analysis comprised of 836 patients that underwent oncologic surgery, 389 before and 447 after PBM, was implemented. Patients in the PBM+ presented significantly more frequent with normal hemoglobin values before surgery than PBM− (56.6 vs. 35.7%; p < 0.001). The number of transfusions was significantly reduced from 5.5 ± 11.1 to 3.0 ± 6.9 units/patient (p < 0.001); moreover, the percentage of patients being transfused during the clinic stay was significantly reduced from 62.4 to 40.9% (p < 0.001). Two-year OS was significantly better in the PBM+ and increased from 67.0 to 80.1% (p = 0.001). A normal hemoglobin value (> 12 g/dl in female and > 13 g/dl in male) before surgery (HR 0.43, 95% CI 0.29–0.65, p < 0.001) was the only independent predictive factor positively affecting survival.ConclusionsPBM is a quality improvement tool that is associated with better mid-term surgical oncologic outcome. The root cause for improvement is the increase of patients entering surgery with normal hemoglobin values.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1456-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

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“…These findings are consistent with the results from the present study. Furthermore, intraoperative transfusion, lymph node metastasis and lymph node ratio have been reported as independent prognostic factors in predicting tumor recurrence (54). However, how intraoperative transfusion may have a negative impact on the recurrence and OS of patients with cancer remains unclear.…”

Section: -Year Os 3-year Os 5-year Os ------------------------------mentioning

confidence: 99%

Development and validation of a novel nomogram for predicting the prognosis of patients with resected pancreatic adenocarcinoma

Ren

Aimaiti

et al. 2020

Oncol Lett

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The survival prediction for patients with resected pancreatic adenocarcinoma by using the Tumor-Node-Metastasis (TNM) staging system remains limited. A nomogram is a efficient tool that can be used to predict the outcome of patients with various types of malignancy. The present study aimed to develop and validate a nomogram for patients with resected pancreatic adenocarcinoma. A total of 368 patients (258 in the training set and 110 in the validation set) who underwent pancreatic adenocarcinoma resection at the China National Cancer Center between January 2008 and October 2018 were included in the present study. The nomogram was established according to the results from Cox multivariate analysis, which was validated by discrimination and calibration. The area under the receiver operating characteristic curve (AUC) was determined to assess the accuracy of survival predictions. The results from multivariate analysis in the training set demonstrated that blood transfusion, T-stage, N-stage, tumor grade, capsule invasion, carbohydrate antigen 199, neutrophil percentage and adjuvant therapy were independent prognostic factors for overall survival (OS; all P<0.05). Subsequently, a nomogram predicting the 1-year, 3-year and 5-year OS rates, with favorable calibration, was established based on the independent prognostic factors. The concordance indices of the nomogram were higher compared with the TNM staging system in both training and validation sets. Furthermore, a clear risk stratification system based on the nomogram was used to classify patients into the three following groups: Low-risk group (≤168), moderate-risk group (168-255) and high-risk group (>255). The risk stratification system demonstrated an improved ability in predicting the 1-year, 3-year and 5-year OS rates compared with the TNM system (AUC, 0.758, 0.709 and 0.672 vs. AUC, 0.614, 0.604 and 0.568; all P<0.05). The present study developed and validated a nomogram for patients with resected pancreatic adenocarcinoma by including additional independent prognostic factors, including tumor marker, immune index, surgical information, pathological data and adjuvant therapy. Taken together, the results from the present study indicated an improved performance of the nomogram in predicting the prognosis of patients with resected pancreatic adenocarcinoma compared with the TNM staging system.

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“…Factors such as availability of combined resection, operation time, amount of blood loss, and availability of transfusion are decided at the time of surgery and could play a role in improving survival and recurrence rates of patients who undergo pancreatectomy. Of these factors, we focused on transfusion and their inappropriate performance during pancreatectomy and hypothesized that reduction of such inappropriate transfusions could improve patient outcomes [7]. Given that the interactions of the host immune system and cancer microenvironment play an important role in determining outcome, and the fact that transfusion lowers a patient's immunity and aggravates outcome [8,9], we concluded that intraoperative transfusion (IOT) might lead to poor outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Most, however, focus on the effect of IOT on recurrence and survival in pancreaticoduodenectomy cases and not in other types of pancreatectomy, because of the complicated procedure of pancreaticoduodenectomy [10][11][12]. One particular study suggests that transfusion performed during pancreatectomy for left-sided pancreatic cancer patients is harmful [7]. While that study focused on more than just pancreaticoduodenectomy, it involved a small number of subjects and focused only on left-sided pancreatic cancer; therefore, it is unlikely to provide a strong guideline against transfusion during pancreatic cancer surgery.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Transfusion is Independently Associated with a Worse Prognosis in Resected Pancreatic Cancer—a Retrospective Cohort Analysis

Kim

Choi

Hwang

et al. 2020

JCM

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Backgrounds: Investigate whether intraoperative transfusion is a negative prognostic factor for oncologic outcomes of resected pancreatic cancer. Methods: From June 2004 to January 2014, the medical records of 305 patients were retrospectively reviewed, who underwent pancreatoduodenectomy, pylorus preserving pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy for pancreatic cancer. Patients diagnosed with metastatic disease (n = 3) and locally advanced diseases (n = 15) were excluded during the analysis, and total of 287 patients were analyzed. Results: The recurrence and disease-specific survival rates of the patients who received intraoperative transfusion showed poorer survival outcomes compared to those who did not (P = 0.031, P = 0.010). Through multivariate analysis, T status (HR (hazard ratio) = 2.04, [95% CI (confidence interval): 1.13–3.68], P = 0.018), N status (HR = 1.46 [95% CI: 1.00–2.12], P = 0.045), adjuvant chemotherapy (HR = 0.51, [95% CI: 0.35–0.75], P = 0.001), intraoperative transfusion (HR = 1.94 [95% CI: 1.23–3.07], P = 0.004) were independent prognostic factors of disease-specific survival after surgery. As well, adjuvant chemotherapy (HR = 0.67, [95% CI: 0.46–0.97], P = 0.035) was independently associated with tumor recurrence. Estimated blood loss was one of the most powerful factors associated with intraoperative transfusion (P < 0.001). Conclusions: Intraoperative transfusion can be considered as an independent prognostic factor of resected pancreatic cancer. As well, it can be avoided by following strict transfusion policy and using advanced surgical techniques to minimize bleeding during surgery.

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Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy

Abstract: Intraoperative transfusion should be avoided by gentle operative handling to minimize intraoperative bleeding, and the appropriate transfusion policy should be followed to increase the survival outcome.

Cited by 18 publications

References 41 publications

Patient Blood Management improves outcome in oncologic surgery

Patient Blood Management improves outcome in oncologic surgery

Development and validation of a novel nomogram for predicting the prognosis of patients with resected pancreatic adenocarcinoma

Intraoperative Transfusion is Independently Associated with a Worse Prognosis in Resected Pancreatic Cancer—a Retrospective Cohort Analysis

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