Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis

Abstract

Perioperative blood transfusion has been linked to poorer long-term survival in patients undergoing esophagectomy, presumably due to its potential immunomodulatory effects. This review aims to summarize existing evidence relating to the influence of blood transfusion on long-term survival following esophagectomy for esophageal cancer. A systematic literature search (up to February 2017) was conducted for studies reporting the effects of perioperative blood transfusion on survival following esophagectomy for esophageal cancer. Meta-analysis was used to summate survival outcomes. Twenty observational studies met the criteria for inclusion. Eighteen of these studies compared the outcomes of patients who received allogenic blood transfusion to patients who did not receive this intervention. Meta-analysis of outcomes revealed that allogenic blood transfusion significantly reduced long-term survival (HR = 1.49; 95% CI 1.26 to 1.76; P < 0.001). There appeared to be a dose-related response with patients who received ≥3 units of blood having lower long-term survival compared to patient who received between 0 and 2 units (HR = 1.59; 95% CI 1.31 to 1.93; P < 0.001). Two studies comparing patients who received allogenic versus autologous blood transfusion showed superior survival in the latter group. Factors associated with the requirement for perioperative blood transfusion included: intraoperative blood loss; preoperative hemoglobin; operative approach; operative time, and; presences of advanced disease. These findings indicate that perioperative blood transfusion is associated with significantly worse long-term survival in patients undergoing esophagectomy for esophageal cancer. Autologous donation of blood, meticulous intraoperative hemostasis, and avoidance of unnecessary transfusions may prevent additional deaths attributed to this intervention.

Preoperative hemoglobin count and prognosis of esophageal cancer, a population-based nationwide study in Finland

“…A Japanese study of patients with resectable esophageal cancer found an association between blood transfusions and decreased survival [26]. Also a meta-analysis of singlecenter observational studies found that receiving blood transfusions was a risk factor for worse long-term survival in patients undergoing esophagectomy for cancer [27]. Similar results have been published regarding colorectal cancer [28].…”

Effect of Perioperative Blood Transfusion on the Postoperative Prognosis of Ruptured Hepatocellular Carcinoma Patients With Different BCLC Stages: A Propensity Score Matching Analysis

“…In BCLC-A, the reason why PBT becomes a risk factor for OS and RFS may be the proinflammatory and immunosuppressive effects of red blood cells, which can also present with mixed effects due to the complex contents of transfusion products and numerous potential immunomodulatory mediators ( 34 – 38 ). Allogeneic blood transfusion has been identified as immunosuppressive, but it did not affect the OS and RFS of BCLC stages B and C rHCC, and the specific mechanism needs further analysis.…”

Association Between Epidural Analgesia and Cancer Recurrence or Survival After Surgery for Renal Cell Carcinoma: A Propensity Weighted Analysis

“…Tsivian et al (29) found that perioperative blood transfusion was independently associated with worse oncological outcomes for localized RCC after curative surgery and that the recipients were associated with roughly a two-fold increase in metastatic progression, allcause and RCC-specific mortality. Moreover, negative clinical outcomes were also observed in colon (26,27) and esophageal (30) cancer patients who received transfusion during curativeintent surgeries. Based on these findings, it has been suggested that blood transfusion can influence the different stages of tumor development including initiation, promotion, malignant conversion, invasion and metastasis (24).…”