The influence of allogenic blood transfusion in patients having free-flap primary surgery for oral and oropharyngeal squamous cell carcinoma

Abstract

The influence of perioperative blood transfusion in oral and oropharyngeal squamous cell carcinoma remains uncertain. It is believed that blood transfusion downregulates the immune system and may have an influence on cancer recurrence and survival. In all, 559 consecutive patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma between 1992 and 2002 were included in this study. Known prognostic variables along with transfusion details were obtained from head and neck cancer and blood transfusion service databases, respectively. Adjusting for relevant prognostic factors in Cox regression, the hazard ratio for patients having 3 or more transfused units relative to those not transfused was 1.52 (95% confidence interval (CI) 0.93 -2.47) for diseasespecific and 1.52 (95% CI 1.05 -2.22) for overall mortality. Blood transfusion of 3 or more units might confer a worse prognosis in patients undergoing primary surgery for oral and oropharyngeal squamous cell carcinoma. Therefore, every effort should be made to limit the amount of blood transfused to the minimum requirement.

What makes a good flap go bad?: A critical analysis of the literature of intraoperative factors related to free flap failure

“…Haughey et al reported that a cut‐off value of >7 L of crystalloids during surgery resulted in major medical and flap complications. Although several authors demonstrated that preoperatively low hemoglobin levels can have adverse effects on flap success rates,14, 15 there is little support for correction of mild to moderate anemia with blood transfusions due to fear of increased blood viscosity 15, 16…”

Use of a leucocyte filter to remove tumour cells from intra‐operative cell salvage blood

“…They also showed that natural killer cell activity remained higher in the autologous group (p < 0.05) and suggested this as a possible mechanism influencing survival [10]. Furthermore, there is evidence that the increased risk for both infection [5] and disease recurrence [61][62][63] is dose related, with the increased risk of recurrence starting at a threshold of 3-4 units of allogeneic blood transfusion, depending on tumour type.…”

Emerging Paradigms in Perioperative Management for Microsurgical Free Tissue Transfer

“…61 In addition, perioperative blood transfusions have a well-documented association with increased morbidity and mortality, including head and neck cancer recurrence, in free flap reconstruction. 26,27,[62][63][64][65][66][67][68][69] Other studies have suggested a link between blood transfusions and wound infections. 69,70 This association may be caused by an immunomodulatory effect of blood transfusions.…”