The Impact of Homologous Packed Red Blood Cell Transfusion on Patients’ Survival after Radical Surgical Treatment of Colorectal Cancer

Abstract

The aim of this study was to assess the impact of homologous packed red blood cell transfusion on patients' survival after radical surgical treatment of colorectal cancer. We analyzed a group of 257 colorectal cancer patients who had undergone radical operations (R0 resection) and who had been followed-up for at least 30 months. Overall survival (OS), disease specific survival (DSS), disease free survival (DFS), free of local recurrence survival (FLR) and free of metastases survival (FM) were recorded. 122 (47.5%) patients received packed red blood cells in the peri-operative period (group T), whereas 135 patients did not receive any blood (group NT). Neither group (T and NT) differed in clinical outcome, non-haemorrhagic complications, cause of death during the follow-up period, or results of surgical treatment. The fact of packed red blood cell transfusion was not significantly prognostic of outcome in Cox's multivariate analysis. Also the survival curves of 63 pairs of patients selected from groups T and NT, according to classical prognostic features, had similar courses.

Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis

“…Data on OS were from 24 articles [1–4, 8, 9, 11, 13, 14, 16, 17, 19, 21, 22, 24, 28–30, 32–36, 38]. The random-effects model showed that transfusion could decrease OS significantly (HR, 0.33; 95% CI, 0.24 to 0.41; I 2 = 61.9%; P < 0.0001; Fig.…”

“…Nine articles reported the trigger of transfusion. The comparison between transfusion and non-transfusion on OS was from five of these articles [8, 13, 14, 17, 32]; in the five articles, one [14] used intraoperative bleeding > 1000 ml as a trigger of transfusion, and the other four articles were included in the following meta-analysis. The triggers were Hb ≤ 6 g/dl and Hb ≤ 7–10 g/dl, and the results showed that transfusion could reduce OS compared with non-transfusion if the trigger level was either Hb ≤ 6 g/dl ( I 2 = 0%, HR = 0.28, 95% CI 0.14–0.43, P < 0.0001) or Hb ≤ 7–10 g/dl ( I 2 = 0%, HR = 0.63, 95% CI 0.35–0.90, P < 0.0001) (Fig.…”

Effects of Allogeneic Red Blood Cell Transfusions on Clinical Outcomes in Patients Undergoing Colorectal Cancer Surgery

“…26,29,54,55 This included 2327 patients, and the length of stay was significantly longer in transfused compared to nontransfused patients (17.8 ± 4.8 vs 13.9 ± 4.7 days, P = 0.005). Table 3 shows the result of the stratified IRR meta-analysis for all-cause mortality.…”

“…Seventeen studies7,[29][30][31][35][36][37][38]44,[47][48][49][55][56][57][58][59] reported the number of cancer-related deaths in transfused (31.0%, 1252 cancer-related deaths in 4045 patients) and nontransfused patients (24.4%, 638 deaths in 2614 patients), corresponding to a pooled OR of 1.71 (95%CI 1.43 -2.05). Corresponding incidence rates in 23,098 patient years (transfused) and 16,093 patient years (nontransfused) were 5.4 and 4.0% per year, respectively, leading to an IRR of 1.45 (1.26 -1.66, P < 0.001).…”

Perioperative Blood Transfusions Do Not Impact Overall and Disease-Free Survival After Curative Rectal Cancer Resection

“…Since its first description in 1982 by Burrows and Tartter, 2 several investiga-tions reported decreased overall survival, [3][4][5][6] increased rates of tumor recurrence, 7 and higher morbidity [8][9][10] in patients receiving perioperative blood transfusions after colorectal cancer resection. 14,15 However, several studies did not demonstrate an association between blood transfusion and survival, [16][17][18][19][20][21][22][23][24] and even the analysis of 12,127 patients in a large recent meta-analysis failed to answer the question whether the observed association between blood transfusion and increased cancer recurrence is of causal or coincidental nature. [11][12][13] Consequently, the threshold for giving perioperative blood transfusions has increasingly risen over the past decade.…”