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Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis
Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis
- Source :
- Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus. 31(4)
- Publication Year :
- 2017
-
Abstract
- Perioperative blood transfusion has been linked to poorer long-term survival in patients undergoing esophagectomy, presumably due to its potential immunomodulatory effects. This review aims to summarize existing evidence relating to the influence of blood transfusion on long-term survival following esophagectomy for esophageal cancer. A systematic literature search (up to February 2017) was conducted for studies reporting the effects of perioperative blood transfusion on survival following esophagectomy for esophageal cancer. Meta-analysis was used to summate survival outcomes. Twenty observational studies met the criteria for inclusion. Eighteen of these studies compared the outcomes of patients who received allogenic blood transfusion to patients who did not receive this intervention. Meta-analysis of outcomes revealed that allogenic blood transfusion significantly reduced long-term survival (HR = 1.49; 95% CI 1.26 to 1.76; P < 0.001). There appeared to be a dose-related response with patients who received ≥3 units of blood having lower long-term survival compared to patient who received between 0 and 2 units (HR = 1.59; 95% CI 1.31 to 1.93; P < 0.001). Two studies comparing patients who received allogenic versus autologous blood transfusion showed superior survival in the latter group. Factors associated with the requirement for perioperative blood transfusion included: intraoperative blood loss; preoperative hemoglobin; operative approach; operative time, and; presences of advanced disease. These findings indicate that perioperative blood transfusion is associated with significantly worse long-term survival in patients undergoing esophagectomy for esophageal cancer. Autologous donation of blood, meticulous intraoperative hemostasis, and avoidance of unnecessary transfusions may prevent additional deaths attributed to this intervention.
- Subjects :
- Adult
Male
medicine.medical_specialty
Blood transfusion
Time Factors
Esophageal Neoplasms
medicine.medical_treatment
Perioperative Care
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Blood Transfusion
Survival analysis
Aged
Retrospective Studies
business.industry
Gastroenterology
Retrospective cohort study
General Medicine
Perioperative
Esophageal cancer
Middle Aged
medicine.disease
Survival Analysis
Surgery
Esophagectomy
Observational Studies as Topic
Treatment Outcome
030220 oncology & carcinogenesis
Hemostasis
Meta-analysis
030211 gastroenterology & hepatology
Female
business
Subjects
Details
- ISSN :
- 14422050
- Volume :
- 31
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus
- Accession number :
- edsair.doi.dedup.....8b0c82519694d55e784d6223cc4f6d52