Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

Abstract

The aim of our study was to evaluate the prognostic significance of blood transfusion on recurrence and survival in patients undergoing curative resections for colorectal cancer. Retrospective analysis of prospectively collected data of patients after elective resections for colorectal cancer between January 2001 and December 2009 was undertaken. The main endpoint was overall survival, disease-free survival, and recurrence rate. These data were evaluated in relation to blood transfusion (group A, no blood transfusion; group B, one to two blood transfusions; group C, three and more blood transfusions). A total of 583 patients met the criteria for inclusion in the study. Of these, 132 (22.6 %) patients received blood transfusion in the perioperative period. There were 83 (14.2 %) patients who received one or two blood transfusions and 49 (8.4 %) patients who required three or more transfusions. Patients with three or more transfusions had a significantly worse 5-year overall survival, disease-free survival, and increased incidence of distant recurrences in comparison with the group without transfusion or the group with one or two transfusions. Multivariate analysis showed that the application of three or more blood transfusions is an independent risk factor for overall survival (P 00.001; HR 2.158; 95 % CI 1.370-3.398), disease-free survival (P<0.001; HR 2.514; 95 % CI 1.648-3.836), and the incidence of distant recurrence (P<0.001; HR 2.902; 95 % CI 1.616-5.212). Application of three or more blood transfusions in patients operated for colorectal carcinoma is an adverse prognostic factor. Indications for blood transfusion should be carefully considered not only with regard to the risk of early complications, but also because of the possibility of compromising long-term results.

The impact of screening on short-term outcome after surgery for colorectal cancer

“…Other factors such as a greater number of stage I patients and a higher rate of a laparoscopic approach in the screening group (although not statistical significant) could have had an impact on the reduced need for transfusion. On the other hand, perioperative transfusion is an independent risk factor for a worse oncological outcome (13,14). The nutritional status is a key factor in cancer patients undergoing surgery (15).…”

Perioperative fasting time among cancer patients submitted to gastrointestinal surgeries

“…Our study pointed out association between fasting time and need for blood transfusion. It is important remember that blood transfusion, among colorectal cancer patients, have been associated with increased length of stay, morbidity, recurrence of tumor, decreased long term survival and death (15)(16)(17) . Therefore, it can be deduced that, even if fasting is necessary at some time due to the health condition of gastrointestinal tumor patients, the excessive extension of this fasting time can compromise the recovery, prolongs the hospitalization and increases the chances of complications and even death.…”

The effect of intraoperative hypothermia upon blood transfusion needs and length of stay among gastrointestinal system cancer surgery

“…In this regard, researchers have associated intraoperative bleeding with the recurrence of tumours (Kamei, Kitayama, Yamashita, & Nagawa, ; Katz et al., ), worsening prognoses (Mörner et al., ), and increased mortality (Gunka, Dostalik, Martinek, Gunkova, & Mazur, ; Katz et al., ).…”

“…Therefore, the scientific evidence produced so far recommends that the indications for blood transfusions should be carefully reviewed so as not to compromise the long‐term results, and that measures that reduce perioperative blood loss are extremely important and should be taken based on the risk factors presented by the patient (Gunka et al., ; Saxena et al., ).…”