Abstract:Our study indicates a slightly, but not significantly, negative effect of allogeneic blood transfusion on prognosis of gastric cancer patients. In the subgroup of patients who underwent total gastrectomy, splenectomy seems to invert this mild effect, with a positive influence on overall survival.
“…First, evidence indicates that excessive EBL may by itself impair immunity against cancer cells and nutritional status via loss of plasma constituents [8,27] . Further, patients' immunonutritional status plays an important role in tumor immunity [28] .…”
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.
“…First, evidence indicates that excessive EBL may by itself impair immunity against cancer cells and nutritional status via loss of plasma constituents [8,27] . Further, patients' immunonutritional status plays an important role in tumor immunity [28] .…”
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.
“…For the 2 studies, the indications for blood transfusions were different. One [23] was a multicenter study in Italy in which the indication for transfusion was a hemoglobin level of 8e10 g/dL or hemodynamically significant intraoperative blood loss. The indication in the other study [15] was intraoperative blood loss of >1000 mL or a hemoglobin level of <8 g/dL undertaken in a single center in Japan.…”
Section: Discussionmentioning
confidence: 99%
“…A meta-regression analysis undertaken to explore explanations for tau 2 suggested that geographic area and tumor stage were not the significant sources of heterogeneity (Table 3). Using Galbraith plot, 2 studies [15,23] were found to be sources of heterogeneity (Fig. 4).…”
Section: Heterogeneity Test and Publication Bias For All-cause Mortalitymentioning
In GC patients undergoing curative surgeries, ABTs are associated with a worse prognosis, including all-cause mortality, cancer-related mortality and recurrence. Patient blood management should be investigated further to minimize use of ABT.
“…[12][13][14] Additionally, the interaction of splenectomy with transfusion in patients undergoing GAC resection has been debated. 9,10,12 The adverse effects of perioperative transfusion on patients undergoing curative resection of GAC and other malignancies have been hypothesized to be immune-mediated and perhaps dependent upon an intact spleen.…”
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