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Effect of Perioperative Transfusion on Recurrence and Survival after Gastric Cancer Resection: A 7-Institution Analysis of 765 Patients from the US Gastric Cancer Collaborative

Authors :
Timothy M. Pawlik
Aslam Ejaz
Malcolm H. Squires
Shishir K. Maithel
Edward A. Levine
Carl Schmidt
David A. Kooby
Alexandra W. Acher
Mark Bloomston
Ryan C. Fields
Konstantinos I. Votanopoulos
Emily R. Winslow
George A. Poultsides
Neil Saunders
Linda X. Jin
Sharon M. Weber
David J. Worhunsky
Maria C. Russell
Clifford S. Cho
Charles A. Staley
Source :
Journal of the American College of Surgeons. 221(3)
Publication Year :
2015

Abstract

The prognostic effect of perioperative blood transfusion on recurrence and survival in patients undergoing resection of gastric adenocarcinoma (GAC) remains controversial.All patients who underwent resection for GAC from 2000 to 2012 at the 7 institutions of the US Gastric Cancer Collaborative were identified. The effect of transfusion on recurrence-free (RFS) and overall survival (OS) in the context of adverse clinicopathologic variables was examined by univariate and multivariate regression analyses.Of 965 patients, 765 underwent curative intent R0 resection. Median follow-up was 44 months; 30-day mortalities were excluded. Median estimated blood loss (EBL) was 200 mL, and 168 patients (22%) received perioperative allogeneic blood transfusions. Transfused patients were less likely to receive adjuvant therapy (44% vs 56%; p = 0.01). Transfusion was associated with significantly decreased median RFS (13.5 vs 37.2 months, p0.001). Median OS was similarly decreased in patients receiving transfusions (18.6 vs 49.8 months, p0.001). On multivariate analysis, transfusion remained an independent risk factor for decreased RFS (hazard ratio [HR] 1.63; 95% CI 1.13 to 2.37; p = 0.010) and decreased OS (HR 1.79; 95% CI 1.21 to 2.67; p = 0.004), regardless of EBL or need for splenectomy. Timing (intraoperative vs postoperative) and volume of transfusion did not alter the negative prognostic effect of transfusion on survival.Perioperative allogeneic blood transfusion is associated with decreased RFS and OS after resection of gastric cancer, independent of adverse clinicopathologic factors. This supports the judicious use of perioperative transfusion during resection of gastric cancer.

Details

ISSN :
18791190
Volume :
221
Issue :
3
Database :
OpenAIRE
Journal :
Journal of the American College of Surgeons
Accession number :
edsair.doi.dedup.....a6e3fd1aefdbf778fecbe88e5bc68ea9