Lymphovascular Invasion

Lin

et al. 2018

Sci Rep

Whether blood transfusion exacerbates cancer outcomes after surgery in humans remains inconclusive. We utilized a large cohort to investigate the effect of perioperative blood transfusion on cancer prognosis following colorectal cancer (CRC) resection. Patients with stage I through III CRC undergoing tumour resection at a tertiary medical center between 2005 and 2014 were identified and evaluated through August 2016. Propensity score matching was used to cancel out imbalances in patient characteristics. Postoperative disease-free survival (DFS) and overall survival (OS) were analysed using Cox regression model. A total of 4,030 and 972 patients were analysed before and after propensity score matching. Cox regression analyses demonstrated blood transfusion associated with shorter DFS and OS before and after matching (hazard ratio: 1.41, 95% CI: 1.2–1.66 for DFS; 1.97, 95% CI: 1.6–2.43 for OS). Larger transfusion volume was linked to higher overall mortality (≤4 units vs. nil, HR = 1.58; >4 units vs. nil, HR = 2.32) but not more cancer recurrence. Preoperative anemia was not associated with decreased survival after adjusting covariates. Perioperative blood transfusion was associated with worse cancer prognosis after curative colorectal resection, independently of anemia status. Strategies aimed at minimizing transfusion requirements should be further developed.

Section: Methodsmentioning

confidence: 99%

The Impact of Blood Transfusion on Recurrence and Mortality Following Colorectal Cancer Resection: A Propensity Score Analysis of 4,030 Patients

Lin

et al. 2018

Sci Rep

“…An electronic medical database was used to determine the baseline characteristics and risk factors for cancer recurrence and mortality, including demographics, pre-treatment CEA level 12 , perioperative packed red blood cell (pRBC) transfusion 13 , pathologic findings (tumor differentiation, mucinous or signet-ring histology 9 , lymphovascular invasion 10 , and perineural invasion 11 ); whether preoperative or postoperative adjuvant chemotherapy or radiotherapy was used. Current status of each patient was determined by documentation of follow-up visits to the hospital’s outpatient clinic or subsequent admissions.…”

Section: Methodsmentioning

confidence: 99%

Intraoperative Fentanyl Consumption Does Not Impact Cancer Recurrence or Overall Survival after Curative Colorectal Cancer Resection

Chang

et al. 2017

Sci Rep

Whether opioid use in cancer surgery would promote tumor dissemination in humans is inconclusive. We investigated the effect of intraoperative fentanyl dose on colorectal cancer (CRC) prognosis following resection in this retrospective study. A total of 1679 patients with stage I-III CRC undergoing tumor resection between January 2011 and December 2014 were evaluated through August 2016. Postoperative recurrence-free survival (RFS) and overall survival (OS) were analyzed using Cox regression models. Multivariable Cox regression analysis demonstrated no dose-response association between the amount of fentanyl dose and RFS (adjusted hazard ratio: 1.03, 95% CI: 0.89–1.19) or OS (adjusted hazard ratio: 0.84, 95% CI: 0.64–1.09). Patients were further classified into the high- and low-dose groups by the median of fentanyl dose (3.0 μg·kg−1), and there was no significant difference in RFS or OS between groups, either (adjusted hazard ratio: 0.93, 95% CI: 0.74–1.17 for RFS; 0.79, 95% CI: 0.52–1.19 for OS). We concluded that intraoperative fentanyl consumption has no impact on recurrence-free or overall survival in patients after curative CRC resection.

“…To determine the baseline variables and risk factors for cancer progression and mortality, we used the electronic medical database to collect demographic characteristics, pre-treatment CEA level [ 12 ], amount of packed red blood cell (pRBC) transfusion [ 13 ], pathologic features (tumor differentiation [ 14 ], mucinous or signet-ring histology [ 15 ], lymphovascular invasion [ 16 ], and perineural invasion [ 17 ]) and whether preoperative or postoperative adjuvant chemotherapy or radiotherapy was used. Current status for each patient was determined by documentation of follow-up visits to the hospital’s outpatient clinic or subsequent admissions.…”

Section: Methodsmentioning

confidence: 99%

The effect of epidural analgesia on cancer progression in patients with stage IV colorectal cancer after primary tumor resection: A retrospective cohort study

Chang

et al. 2018

PLoS ONE

Retrospective clinical studies showed perioperative epidural analgesia (EA) was associated with better postoperative oncologic outcomes in patients with specific types of non-metastatic cancers. This study aimed to investigate the effects of EA on cancer prognosis after surgical intervention for stage IV colorectal cancer. In this retrospective study, patients with stage IV colorectal cancer undergoing primary tumor resection and metastasectomy between January 2005 and December 2014 were classified into two groups based on their use of perioperative EA or not and evaluated through August 2016. Primary and secondary endpoints were postoperative progression-free survival (PFS) and overall survival (OS), respectively. A total of 999 patients were included and 165 (16.5%) of them received EA. The median follow-up interval was 17.5 months and no significant difference in PFS or OS was noted between the EA and non-EA groups in the univariate analysis. Multivariable Cox proportional hazards model identified four independent risk factors both for disease progression and mortality, including American Society of Anesthesiologists (ASA) physical status ≥ 3, higher pretreatment carcinoembryonic antigen (CEA), multiple distant metastases, and pathologic lymphovascular invasion. After adjustment for the selected risk factors, the effects of EA on PFS and OS remained non-significant (hazard ratio: 1.06, 95% CI: 0.87 to 1.29, for PFS and 0.90, 95% CI: 0.68 to 1.20 for OS). Similar findings were demonstrated by propensity score analysis. Our results did not support the association between perioperative epidural analgesia and better progression-free or overall survival in patients following stage IV colorectal cancer surgery.