Intraoperative Transfusion is Independently Associated with a Worse Prognosis in Resected Pancreatic Cancer—a Retrospective Cohort Analysis

Abstract

Backgrounds: Investigate whether intraoperative transfusion is a negative prognostic factor for oncologic outcomes of resected pancreatic cancer. Methods: From June 2004 to January 2014, the medical records of 305 patients were retrospectively reviewed, who underwent pancreatoduodenectomy, pylorus preserving pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy for pancreatic cancer. Patients diagnosed with metastatic disease (n = 3) and locally advanced diseases (n = 15) were excluded during the analysis, and total of 287 patients were analyzed. Results: The recurrence and disease-specific survival rates of the patients who received intraoperative transfusion showed poorer survival outcomes compared to those who did not (P = 0.031, P = 0.010). Through multivariate analysis, T status (HR (hazard ratio) = 2.04, [95% CI (confidence interval): 1.13–3.68], P = 0.018), N status (HR = 1.46 [95% CI: 1.00–2.12], P = 0.045), adjuvant chemotherapy (HR = 0.51, [95% CI: 0.35–0.75], P = 0.001), intraoperative transfusion (HR = 1.94 [95% CI: 1.23–3.07], P = 0.004) were independent prognostic factors of disease-specific survival after surgery. As well, adjuvant chemotherapy (HR = 0.67, [95% CI: 0.46–0.97], P = 0.035) was independently associated with tumor recurrence. Estimated blood loss was one of the most powerful factors associated with intraoperative transfusion (P < 0.001). Conclusions: Intraoperative transfusion can be considered as an independent prognostic factor of resected pancreatic cancer. As well, it can be avoided by following strict transfusion policy and using advanced surgical techniques to minimize bleeding during surgery.

Laparoscopic pancreaticoduodenectomy in pancreatic ductal adenocarcinoma

“…First, a minimally invasive surgery can enhance postoperative recovery, thereby preserving the patient's functional capacity and initiating adjuvant chemotherapy promptly. Second, LPD has frequently reduced intraoperative bleeding, thus lowering the risk of an intraoperative transfusion, which is known to adversely impact patient survival [9]. Although margin-negative radical pancreatectomy is most effective in treating pancreatic cancer, more than 80% of pancreatic cancer patients have unresectable tumors at the time of diagnosis.…”

Predictors of 90-Day Mortality following Hepatic Resection for Hepatocellular Carcinoma

“…Intraoperative bleeding and blood transfusion are essential considerations in surgical oncology and reported to impact both perioperative and oncologic outcomes [30,31]. The threshold for transfusion of blood at a hemoglobin level < 8 g/dL is widely adopted internationally.…”

Is Laparoscopic Pancreaticoduodenectomy Feasible for Pancreatic Ductal Adenocarcinoma?

“…Potential deleterious effects of blood transfusion on oncologic outcomes have been explained by several hypothesized mechanisms, primarily via the induction of immunosuppression [ 88 , 89 ]. In several studies, intraoperative transfusion was found to be one of the independent prognostic factors in resected pancreatic cancer [ 90 , 91 , 92 ]. In addition, a recent meta-analysis [ 35 ] to evaluate potential relationship between perioperative blood transfusion and prognosis of pancreatic cancer surgery also demonstrated detrimental effect of blood transfusion on survival in univariate (68.4%, 13 out of 19 studies) and multivariate analysis (47.4%, 9 out of 19 studies) respectively, showing overall blood transfusion associated with pancreatic cancer surgery can be related to shorter overall survival (pooled odds ratio 2.43, 95% confidence interval 1.90–3.10).…”