Allogenic Blood Transfusion is Associated with Poor Perioperative and Long‐Term Outcome in Esophageal Cancer

Reeh, Matthias; Ghadban, Tarik; Dedow, Josephine; Vettorazzi, Eik; Uzunoğlu, Faik G.; Nentwich, Michael F.; Kluge, Stefan; Izbicki, Jakob R.; Vashist, Yogesh K.

doi:10.1007/s00268-016-3730-8

Cited by 40 publications

(33 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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: Discussionsupporting

confidence: 84%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 84%

Patient Blood Management improves outcome in oncologic surgery

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Peri-operative blood transfusions are routinely used during cancer surgeries, however, many retrospective studies have reported increased recurrence, post-operative infection rates, and morbidity as a result of blood transfusions [ 78 , 79 , 80 ]. Gharehbaghian et al demonstrated that use of autologous salvaged blood, instead of allogenic blood for transfusion, increased the proportion of NK cell precursors and IFNγ production post-surgery [ 81 ].…”

Section: Surgical Stress Inflammation and Natural Killer Cell Dysmentioning

confidence: 99%

Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery

Angka

Khan

Kilgour

et al. 2017

IJMS

View full text Add to dashboard Cite

The physiological changes that occur immediately following cancer surgeries initiate a chain of events that ultimately result in a short pro-, followed by a prolonged anti-, inflammatory period. Natural Killer (NK) cells are severely affected during this period in the recovering cancer patient. NK cells play a crucial role in anti-tumour immunity because of their innate ability to differentiate between malignant versus normal cells. Therefore, an opportunity arises in the aftermath of cancer surgery for residual cancer cells, including distant metastases, to gain a foothold in the absence of NK cell surveillance. Here, we describe the post-operative environment and how the release of sympathetic stress-related factors (e.g., cortisol, prostaglandins, catecholamines), anti-inflammatory cytokines (e.g., IL-6, TGF-β), and myeloid derived suppressor cells, mediate NK cell dysfunction. A snapshot of current and recently completed clinical trials specifically addressing NK cell dysfunction post-surgery is also discussed. In collecting and summarizing results from these different aspects of the surgical stress response, a comprehensive view of the NK cell suppressive effects of surgery is presented. Peri-operative therapies to mitigate NK cell suppression in the post-operative period could improve curative outcomes following cancer surgery.

show abstract

“…[ 3 ] Perioperative blood transfusion is also associated with cancer recurrence and metastasis. [ 13 ] Perioperative blood transfusion has been reported to increase postoperative mortality, local recurrence, and distant metastasis in patients with colorectal cancer. [ 14 ] It was also reported that blood transfusion was associated with poor prognosis in patients with esophageal cancer.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 ] It was also reported that blood transfusion was associated with poor prognosis in patients with esophageal cancer. [ 13 ] One study also reported that the immunosuppressive effects of blood transfusions increased the recurrence of head and neck tumors, resulting in a poor prognosis. [ 15 ] Another study showed an association between recurrence of advanced ovarian cancer after cytoreductive surgery and perioperative allogeneic blood transfusion.…”

Section: Discussionmentioning

confidence: 99%

Impact of intraoperative allogenic and autologous transfusion on immune function and prognosis in patients with hepatocellular carcinoma

et al. 2020

View full text Add to dashboard Cite

The effect of intraoperative blood transfusion on the immune function and prognosis of hepatocellular carcinoma (HCC) has not been fully investigated. The aim of this study was to evaluate the effects of intraoperative autologous blood transfusion and allogeneic blood transfusion on immune function and prognosis in surgically treated HCC patients. One hundred fourteen primary hepatic carcinoma patients who would undergo selective operations were divided into two groups, 35 patients in the experimental group received intraoperative autologous blood transfusion and 79 patients in the control group received allogeneic blood transfusion. The amount of serum T lymphocyte subsets, natural killer (NK) cells and immunoglobulin before and after operation, as well as the recurrence-free survival (RFS) were compared. Results shown that, there was no significant difference in the level of immunocytes and immunoglobulin between the two groups before treatment ( P > .05). At 1 day after surgery, there were significant differences in T lymphocyte, NK cells and immunoglobulin levels before and after transfusion. CD3+, CD4+, CD4+/CD8+, and NK cells in autologous transfusion group were significantly higher than those in allogeneic transfusion group ( P < .05); the level of IgG, IgM, and IgA in allogeneic transfusion group were significantly lower than those before operation ( P < .05), the level of IgG, IgM, and IgA in autologous transfusion group did not significantly fluctuate, and significantly higher than those of allogeneic transfusion group ( P < .05). At 5 days after surgery, all indexes of autologous transfusion group recovered to the preoperative level, the levels of CD3+, CD4+, CD4+/CD8+, NK cells, IgG, IgM, and IgA were significantly higher than those of allogeneic transfusion group ( P < .05). The follow-up results showed that the RFS of autologous transfusion group was significantly higher than that of allogeneic transfusion group ( P < .05). In conclusion, compared with allogeneic blood transfusion, intraoperative autologous blood transfusion possessed less impact on immune function, it may even improve immune function and RFS in HCC patients after surgery. Therefore, HCC patients should be recommended to receive autologous blood transfusion instead of allogeneic blood transfusion when they need blood transfusion during the perioperative period.

show abstract

Allogenic Blood Transfusion is Associated with Poor Perioperative and Long‐Term Outcome in Esophageal Cancer

Abstract: Allogenic blood transfusion has a significant impact on the natural course of EC after complete resection. The poor short-term and long-term outcome warrants further evaluation of the underlying molecular mechanisms induced by allogenic blood transfusion in cancer patients.

Cited by 40 publications

References 42 publications

Patient Blood Management improves outcome in oncologic surgery

Patient Blood Management improves outcome in oncologic surgery

Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery

Impact of intraoperative allogenic and autologous transfusion on immune function and prognosis in patients with hepatocellular carcinoma

Contact Info

Product

Resources

About