No impact of perioperative blood transfusion on prognosis after curative resection for hepatocellular carcinoma: a propensity score matching analysis

Abstract

The present study demonstrates that perioperative blood transfusion has no impact on disease-free and overall survival after curative resection for HCC.

Perioperative blood transfusion has distinct postsurgical oncologic impact on patients with different stage of hepatocellular carcinoma

“…The impact of PBT on survival outcomes for HCC has been debated for more than two decades [7][8][9][10][11][12][20][21][22][23][24].…”

“…In 2013, one metaanalysis involved 22 retrospective studies with 5635 Variables are not included in the matching model Abbreviation: ABLI grade albumin to bilirubin grade, ALT anlanine transaminase, NLR neutrophil to lymphocyte ratio, PLR platelet to lymphocyte ratio, APRI alanine transaminase to platelet ratio index, PVTT portal vein tumor thrombus, HVTT hepatic vein tumor thrombus, MVI microscopic vascular invasion, AFP alpha fetoprotein, PLR platelet to lymphocyte ratio patients concluded that PBT had a negative effect on oncologic outcomes for HCC after resection [12]. However, five studies published recently still yielded controversial conclusions, although they all deliberately used a PSM analysis to adjust patient selection bias [7][8][9][10][11]. Resectable HCC comprised of different stage of disease, from BCLC stage 0 to C, which had large heterogeneity among patients and tumors.…”

“…Blood transfusion is still a life-saving therapy when excessive intraoperative bleeding occurs, but it involves the risk of transfusion-related complications, such as transmission of hepatitis viruses, human immunodeficiency virus, and allergic reactions [6]. Regarding oncologic outcomes, although many studies had been reported, the influence of perioperative blood transfusion (PBT) on postoperative survival outcomes is controversial [7][8][9][10][11][12]. Furthermore, the influence of PBT on different stage of resectable HCC has not been well investigated.…”

2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma

“…287 However, a recent meta-analysis study reported that intraoperative or postoperative blood transfusion was not associated with DFS. 288,289 Recent transfusion rates in hepatic resection are ≤10% owing to selective hepatic blood flow occlusion, maintenance of low central venous pressure, and precise transection of the hepatic parenchyma. 290 However, a recent prospective randomized study reported that goal-directed fluid therapy based on the stroke volume was sufficient to minimize bleeding, without the need to unconditionally lower the central venous pressure during surgery.…”

2022 KLCA-NCC Korea Practice Guidelines for the Management of Hepatocellular Carcinoma

“…Blood transfusion has been reported to compromise anticancer immunologic mechanisms and increase postoperative recurrence [ 287 ]. However, a recent meta-analysis study reported that intraoperative or postoperative blood transfusion was not associated with DFS [ 288 289 ]. Recent transfusion rates in hepatic resection are ≤ 10% owing to selective hepatic blood flow occlusion, maintenance of low central venous pressure, and precise transection of the hepatic parenchyma [ 290 ].…”