The Importance of Blood Loss During Colon Cancer Surgery for Long-Term Survival

Mörner, Malin E M; Gunnarsson, Ulf; Jestin, Pia; Svanfeldt, Monika

doi:10.1097/sla.0b013e3182512df0

Cited by 73 publications

(63 citation statements)

References 15 publications

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“…Radical therapeutic strategies for colon cancer include laparoscopic resection and open resection. In particular, laparoscopic radical resection has several advantages, including minimal invasion, rapid post-operative recovery, less bleeding, and fewer complications (Mörner et al, 2012). All subjects enrolled in this study underwent laparoscopic radical resection of colon cancer, thereby minimizing the potential impact of radical resectionassociated complications and adverse effects on data interpretation.…”

Section: Discussionmentioning

confidence: 99%

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

Wang¹,

et al. 2016

Genet. Mol. Res.

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ABSTRACT. The aim of this study was to investigate the clinical significance of the expression of DNA mismatch repair (MMR) genes in patients subjected to radical surgical removal of colon cancer, as well as their correlation with disease prognosis. Ninety stage II and III colon cancer patients who received laparoscopic radical resection of colon cancer at our hospital were recruited in this study. The expression of hMLH1, hMSH2, hMSH6, and hPMS2 in the resected tumor tissues was examined by SP immunohistochemistry, in order to analyze the 2 J.B. Wang et al. Genetics and Molecular Research 15 (3): gmr.15038388 relationship between defective DNA MMR (dMMR) and the clinicopathological features and prognosis of colon cancer. Patients were followed up over a period of 5-35 months, and the Kaplan-Meier survival curve was plotted. dMMR was confirmed in 27 subjects (30.0%), among whom recurrence with metastasis and death was reported in 5 (18.5%) and 2 (7.4%) patients, respectively. The remaining 63 subjects displayed proficient DNA MMR (pMMR); among these, 19 (30.2%) and 7 (11.1%) recurrences with metastasis and death were reported, respectively. dMMR showed no significant correlation with gender, age, or therapeutic modality (P > 0.05), but was significantly correlated with the degree of differentiation, tumor location, number of resected lymph nodes, presence of ileus, and TNM stage (P < 0.05). The prognosis of patients with dMMR was better than that of patients with pMMR. dMMR serves as a biomarker for the prognosis of stage II/III colon cancers.

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Section: Discussionmentioning

confidence: 99%

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

Wang¹,

et al. 2016

Genet. Mol. Res.

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“…First, evidence indicates that excessive EBL may by itself impair immunity against cancer cells and nutritional status via loss of plasma constituents [8,27] . Further, patients' immunonutritional status plays an important role in tumor immunity [28] .…”

Section: Discussionmentioning

confidence: 99%

“…The influence of EBL on postoperative long-term outcome has been a subject of debate in the field of oncological surgery, and the adverse effect of overt EBL has been demonstrated in colorectal and pancreatic cancer [7,8] . In GC, patients who underwent perioperative blood transfusion have been associated with poor outcome [9] , but this could be due to the immunological effect of blood transfusion per se, and whether the EBL can affect the outcome by itself is unknown.…”

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confidence: 99%

“…mated blood loss (EBL) during gastrectomy has been reported [7,8], possibly because of improvements in surgical technique, devices, and approach, gastrectomy with systemic lymphadenectomy sometimes causes excessive bleeding even in the hands of experienced surgeons. The influence of EBL on postoperative long-term outcome has been a subject of debate in the field of oncological surgery, and the adverse effect of overt EBL has been demonstrated in colorectal and pancreatic cancer [7,8] .…”

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Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer

et al. 2016

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Background/Aims: Gastrectomy with systemic lymphadenectomy sometimes causes excessive bleeding even by experienced surgeons. The aim of this study was to evaluate how intraoperative estimated blood loss (EBL) affected the long-term outcomes after curative surgery of patients with stage II/III gastric cancer (GC). Methods: This study included 203 patients with stage II/III GC who did not receive perioperative blood transfusion between 1999 and 2015. The optimal cutoff and the prognostic significance of EBL were determined retrospectively. Results: The median EBL was 285 ml. Receiver operating characteristic curve analysis identified 400 ml as an optimal cutoff. Patients with EBL ≥400 ml were more likely to have hepatic relapse and worse prognosis compared to those with EBL <400 ml. EBL ≥400 ml was identified as an independent prognostic factor for mortality by multivariable analysis. When patients were subdivided according to administration of adjuvant chemotherapy, there was a significant difference between the EBL ≥400 and <400 ml groups in patients who underwent surgery alone, whereas the prognosis was similar for patients of both groups who received adjuvant chemotherapy. Conclusion: EBL serves as a useful predictor for risk stratification after curative gastrectomy in patients with stage II/III GC.

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“…The degree of blood loss during surgery for colon cancer has previously been shown to influence long-term survival when including both elective and emergency operations [20] . In contrast, in this study on emergencyoperated patients, blood loss did not affect the risk for Brännström Ref.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

Brännström

Gunnarsson²

2016

Dig Surg

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Background/Aims: Patients undergoing emergency resection for colon cancer have a worse outcome both in terms of short- and long-term survival than those having elective surgery. The aim of this population-based study was to determine factors associated with increased risk for local recurrence following emergency resection. Methods: The Stockholm-Gotland Healthcare Region Colon Cancer Register was used to identify all colon cancer patients who had undergone emergency colon resection with curative intent in that region 1997-2007. Patient records were scrutinised to obtain any missing information. The influence of the following factors was assessed: indication for emergency resection; time between admission and surgery; surgery daytime or at night; American Association of Anesthesiologists score; volume of blood lost; and T- and N-stage. Our endpoint was loco-regional recurrence. Results: Apart from stage, perforation as indication for emergency surgery was the only factor that influenced the risk for local recurrence (hazard ratio 1.96; 95% CI 1.12-3.43). Conclusion: In this study, the only factor associated with local recurrence after emergency resection for colon cancer was preoperative perforation. This implies that changes in our current management algorithm would be unlikely to lead to improvement. Efforts should therefore concentrate on reducing the proportion of patients operated on an emergency basis.

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The Importance of Blood Loss During Colon Cancer Surgery for Long-Term Survival

Abstract: The results support the hypothesis that degree of blood loss during surgery for colon cancer is a factor that influences long-term survival.

Cited by 73 publications

References 15 publications

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

Association between expression of DNA mismatch repair genes and clinical features and prognosis of patients with radical resection of colon cancer

Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer

Risk Factors for Local Recurrence after Emergency Resection for Colon Cancer: Scenario in Sweden

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