Impact of Blood Transfusions and Transfusion Practices on Long-Term Outcome Following Hepatopancreaticobiliary Surgery

Abstract

Adoption of a more restrictive transfusion strategy in patients undergoing resection for cancer may preserve a limited resource, reduce costs, as well as avoid exposing oncology patients to the unnecessary risks associated with a transfusion.

Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis

“…19,20,33 Despite recent research assessing the long-term outcomes of PBT among patients undergoing pancreatic surgery, large variations exist in clinical practice and adherence to transfusion guidelines. 3,13 The current study systematically reviewed all published evidence before January 10, 2015, pertaining to patients undergoing pancreatic surgery and synthesized data from 3646 patients using the methodology of metaanalysis. Our analysis demonstrated that PBT was associated with a nearly 2.5 times lower 5-year OS (OR 2.43, 95 % CI 1.90-3.10) irrespective of the indication for surgery.…”

“…2 Given the high incidence of perioperative anemia, patients undergoing complex oncologic surgery are of particular interest as blood transfusion are frequently utilized among this highrisk cohort. 3 Although blood transfusions can be critical to maintaining hemodynamic stability in the setting of acute hemorrhage, recent reports have associated perioperative blood transfusions (PBT) with poor short-and long-term perioperative outcomes among patients undergoing surgery for colorectal, gastric and thoracic malignancies. [4][5][6] Specifically, PBT has been associated with a higher Michael N. Mavros and Li Xu have contributed equally to this project.…”

“…[10][11][12] Although several studies have assessed the impact of blood transfusions on long-term oncologic outcomes among patients undergoing pancreatic resections, the results have been conflicting. 3,13 For example, Ejaz et al reported a worse overall survival (OS), as well as a worse recurrence-free survival among patients who underwent HPB surgery, whereas Clark et al noted that blood transfusion did not adversely affect long-term outcomes among patients with resected pancreatic cancer. 3,13 Similarly, transfusion practices and adherence to evidence-based guidelines among HPB surgeons remains varied.…”

“…3,13 For example, Ejaz et al reported a worse overall survival (OS), as well as a worse recurrence-free survival among patients who underwent HPB surgery, whereas Clark et al noted that blood transfusion did not adversely affect long-term outcomes among patients with resected pancreatic cancer. 3,13 Similarly, transfusion practices and adherence to evidence-based guidelines among HPB surgeons remains varied. Given this, we sought to systematically review the available evidence regarding the impact of PBT on longterm outcomes of patients undergoing pancreatic surgery (pancreaticoduodenectomy and distal pancreatectomy) and synthesize the published data using meta-analysis methodology.…”

Red Cell Transfusion Triggers and Postoperative Outcomes After Major Surgery

“…4,[8][9][10] Our group and others have also noted that transfusion can possibly be related to worse long-term oncological outcomes. 11,12 As such, there is an increasing interest in trying to minimize patient exposure to unnecessary transfusions. Several randomized controlled trials have noted that a restrictive red cell transfusion strategy was as safe and effective as a more liberal transfusion strategy.…”