1
|
Zhang W, Xu H, Huang B, Xu Y, Huang J. Association of perioperative allogeneic blood transfusions and long-term outcomes following radical surgery for gastric and colorectal cancers: systematic review and meta-analysis of propensity-adjusted observational studies. BJS Open 2023; 7:zrad075. [PMID: 37584435 PMCID: PMC10428665 DOI: 10.1093/bjsopen/zrad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 06/24/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Previous meta-analyses reporting significant associations between perioperative allogeneic blood transfusions and poor prognosis in gastric cancer or colorectal cancer had a high risk of confounding bias. This meta-analysis explored this issue using observational studies that applied propensity score analysis. METHODS PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched for manuscripts published between 2013 and 2022. Studies applying propensity score analysis were included to investigate the association between perioperative allogeneic blood transfusions and prognosis in gastric cancer or colorectal cancer after radical surgery. Pooled HRs for overall survival and disease-free survival were calculated using a fixed-effect model or random-effect model according to heterogeneity. RESULTS Twelve retrospective cohort studies with 17 607 patients reported were included. Ten studies applied propensity score matching and two applied inverse probability of treatment weighting using propensity score. A total of 5962 patients were analysed after propensity score adjustment. After propensity score adjustment, perioperative allogeneic blood transfusions did not correlate with disease-free survival in gastric cancer (HR 1.16; 95 per cent c.i. 0.96-1.39; heterogeneity was assessed by the chi-squared test and inconsistency index (I2) = 57 per cent) or colorectal cancer (HR 1.12; 95 per cent c.i. 0.84-1.49; I2 = 54 per cent). However, after propensity score adjustment, perioperative allogeneic blood transfusions were significantly associated with worse overall survival in gastric cancer (HR 1.20; 95 per cent c.i. 1.08-1.32; I2 = 25 per cent) and colorectal cancer (HR 1.40; 95 per cent c.i. 1.06-1.85; I2 = 52 per cent). Subgroup analyses showed that perioperative allogeneic blood transfusions did not correlate with overall survival in colorectal cancer when major postoperative complications were balanced after propensity score. CONCLUSION Perioperative allogeneic blood transfusion is not correlated with recurrence of gastric cancer and colorectal cancer. Perioperative allogeneic blood transfusions are significantly associated with worse overall survival in gastric cancer and colorectal cancer, which may be attributable to unbalanced major postoperative complications after propensity score adjustment.
Collapse
Affiliation(s)
- Weilan Zhang
- Department of Radiology, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China
| | - Huimian Xu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China
| | - Baojun Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China
| | - Yan Xu
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China
| | - Jinyu Huang
- Department of Surgical Oncology and General Surgery, The First Hospital of China Medical University; Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors (China Medical University), Ministry of Education, Shenyang, China
| |
Collapse
|
2
|
Wang W, Zhao L, Niu P, Zhang X, Luan X, Zhao D, Chen Y. Effects of perioperative blood transfusion in gastric cancer patients undergoing gastrectomy: A systematic review and meta-analysis. Front Surg 2023; 9:1011005. [PMID: 36733678 PMCID: PMC9887286 DOI: 10.3389/fsurg.2022.1011005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background The short-term and long-term effects of perioperative blood transfusion (PBT) on patients with gastric cancer are still intriguing. This systematic review and meta-analysis aimed to investigate the effects of blood transfusion on clinical outcomes in patients with gastric cancer undergoing gastrectomy. Methods We searched PubMed, Web of Science, Embase, and The Cochrane Library on December 31th 2021. The main outcomes were overall survival (OS), disease-free survival (DFS), disease-specific survival (DFS), and postoperative complications. A fixed or random-effects model was used to calculate the hazard ratio (HR) with 95% confidence intervals (CIs). Results Fifty-one studies with a total of 41,864 patients were included for this review and meta-analysis. Compared with patients who did not receive blood transfusions (NPBT), PBT was associated with worse 5-year OS (HR = 2.39 [95%CI: 2.00, 2.84]; p < 0.001; Multivariate HR = 1.43 [95%CI: 1.24, 1.63]; p < 0. 001), worse 5-year DFS (HR = 2.26 [95%CI: 1.68, 3.05]; p < 0.001; Multivariate HR = 1.45 [95%CI: 1.16, 1.82]; p < 0. 001), and worse 5-year DSS (HR = 2. 23 [95%CI: 1.35, 3.70]; p < 0.001; Multivariate HR = 1.24 [95%CI: 0.96, 1.60]; p < 0.001). Moreover, The PBT group showed a higher incidence of postoperative complications [OR = 2.30 (95%CI:1.78, 2. 97); p < 0.001] than that in the NPBT group, especially grade III-V complications, according to the Clavien-Dindo classification. [OR = 2.50 (95%CI:1.71, 3.63); p < 0.001]. Conclusion In patients who underwent gastrectomy, PBT was associated with negative survival effects (OS, DFS, DSS) and a higher incidence of perioperative complications. However, more research was expected to further explore the impact of PBT. Meanwhile, strict blood transfusion management should be implemented to minimize the use of PBT.
Collapse
|
3
|
Puértolas N, Osorio J, Jericó C, Miranda C, Santamaría M, Artigau E, Galofré G, Garsot E, Luna A, Aldeano A, Olona C, Molinas J, Pulido L, Gimeno M, Pera M. Effect of Perioperative Blood Transfusions and Infectious Complications on Inflammatory Activation and Long-Term Survival Following Gastric Cancer Resection. Cancers (Basel) 2022; 15:cancers15010144. [PMID: 36612141 PMCID: PMC9818188 DOI: 10.3390/cancers15010144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06−2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14−2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40−1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88−2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64−4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence.
Collapse
Affiliation(s)
- Noelia Puértolas
- Service of Surgery, Hospital Universitari Mútua Terrassa, 08221 Terrassa, Spain
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
| | - Javier Osorio
- Department of Surgery, Hospital Universitari de Bellvitge, L’Hospitalet del Llobregat, 08037 Barcelona, Spain
- Correspondence: ; Tel.: +34-637286009
| | - Carlos Jericó
- Service of Internal Medicine, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Coro Miranda
- Service of Surgery, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Maite Santamaría
- Service of Surgery, Hospital Universitari Arnau de Vilanova, 25198 Lleida, Spain
| | - Eva Artigau
- Service of Surgery, Hospital Universitari Josep Trueta, 17007 Girona, Spain
| | - Gonzalo Galofré
- Service of Surgery, Hospital de Sant Joan Despí Moisès Broggi, 08970 Sant Joan Despí, Spain
| | - Elisenda Garsot
- Service of Surgery, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Alexis Luna
- Service of Surgery, Consorci Corporació Sanitària Parc Taulí de Sabadell, 08208 Sabadell, Spain
| | - Aurora Aldeano
- Service of Surgery, Hospital General de Granollers, 08402 Granollers, Spain
| | - Carles Olona
- Service of Surgery, Hospital Universitari de Tarragona, Joan XXIII, 43005 Tarragona, Spain
| | - Joan Molinas
- Service of Surgery, Hospital Universitari de Vic, 08500 Vic, Spain
| | - Laura Pulido
- Service of Surgery, Hospital de Mataró, Consorci Sanitari del Maresme, 08304 Mataró, Spain
| | - Marta Gimeno
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery, Hospital Universitario del Mar, Universitat Autònoma de Barcelona, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain
| |
Collapse
|
4
|
Zhi X, Kuang X, Li J. The Impact of Perioperative Events on Cancer Recurrence and Metastasis in Patients after Radical Gastrectomy: A Review. Cancers (Basel) 2022; 14:cancers14143496. [PMID: 35884557 PMCID: PMC9319233 DOI: 10.3390/cancers14143496] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 02/04/2023] Open
Abstract
Radical gastrectomy is a mainstay therapy for patients with locally resectable gastric cancer (GC). GC patients who are candidates for radical gastrectomy will experience at least part of the following perioperative events: surgery, anesthesia, pain, intraoperative blood loss, allogeneic blood transfusion, postoperative complications, and their related anxiety, depression and stress response. Considerable clinical studies have shown that these perioperative events can promote recurrence and decrease the long-term survival of GC patients. The mechanisms include activation of neural signaling and the inflammatory response, suppression of antimetastatic immunity, increased release of cancer cells into circulation, and delayed adjuvant therapy, which are involved in every step of the invasion-metastasis cascade. Having appreciated these perioperative events and their influence on the risk of GC recurrence, we can now use this knowledge to find strategies that might substantially prevent the deleterious recurrence-promoting effects of perioperative events, potentially increasing cancer-free survival in GC patients.
Collapse
Affiliation(s)
- Xing Zhi
- Department of General Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, China;
| | - Xiaohong Kuang
- Department of Hematology, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, China;
| | - Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, China
- Correspondence: ; Tel.:+86-0816-2271901
| |
Collapse
|
5
|
Song JH, Shin HJ, Lee S, Park SH, Cho M, Kim YM, Hyung WJ, Kim HI. No detrimental effect of perioperative blood transfusion on recurrence in 2905 stage II/III gastric cancer patients: A propensity-score matching analysis. Eur J Surg Oncol 2022; 48:2132-2140. [DOI: 10.1016/j.ejso.2022.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/17/2022] [Accepted: 05/27/2022] [Indexed: 02/07/2023] Open
|
6
|
Kuang XH, Li J. Dilemma in selection of treatment for preoperative anemia in patients with gastric cancer. Shijie Huaren Xiaohua Zazhi 2022; 30:92-99. [DOI: 10.11569/wcjd.v30.i2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
One of the common comorbidities of patients with gastric cancer waiting for gastrectomy is anemia, which negatively affects the postoperative outcomes and prognosis. Therefore, preoperative anemia often needs to be corrected. The most commonly used strategy to treat preoperative anemia in gastric cancer is transfusion. Currently, a large amount of evidence shows that transfusion can increase the incidence of postoperative complications and affect the long-term survival of patients. Therefore, there is a dilemma in choosing the treatment for preoperative anemia in patients with gastric cancer. Surgeons need to fully understand the duality of therapy strategies for preoperative anemia in gastric cancer patients. In this study, we review the studies on preoperative anemia and its treatment in patients with gastric cancer, aiming to help clinicians manage patients undergoing gastrectomy for cancer better.
Collapse
|
7
|
Molodysky E, Grant R. Person-to-Person Cancer Transmission via Allogenic Blood Transfusion. Asian Pac J Cancer Prev 2021; 22:641-649. [PMID: 33773525 PMCID: PMC8286663 DOI: 10.31557/apjcp.2021.22.3.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/03/2021] [Indexed: 11/25/2022] Open
Abstract
Despite the recognized capability of Circulating Tumor Cells (CTCs) to seed tumors, allogenic blood transfusions are not presently screened for the presence of CTCs. Previous research has examined blood transfusions and the associated risk of cancer recurrence, but not cancer of unknown primary (CUP) occurrence. The Hypothesis explored in this paper proposes that there is potential for cancers to be transmitted from donor-to-patient via CTCs in either blood transfusions or organ transplants or both. This proposed haematogenic tumor transmission will be discussed in relation to two scenarios involving the introduction of donor-derived CTC's from allogeneic blood transfusions into either known cancer surgery patients or into non-cancer patients. The source of CTCs arises either from the donor with a 'clinically dormant cancer' or a 'pre-clinical cancer' existing as yet undiagnosed, in the donor. Given the significant number of allogenic blood transfusions that occur worldwide on a yearly basis, allogenic blood transfusions have the potential to expose a substantial number of non-cancer recipients to the transmission of CTCs and associated tumor risk. This risk is greatly amplified in the low-income nations where the blood collection and processing protocols, including exclusion and screening criteria are less stringent than those in high-income countries.
Collapse
Affiliation(s)
- Eugen Molodysky
- Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Ross Grant
- Sydney Medical School, University of Sydney, Sydney, Australia.
- School of Medical Sciences, University of NSW, Sydney, Australia.
- Australasian Research Institute, Sydney Adventist Hospital, Wahroonga, Sydney Australia.
| |
Collapse
|
8
|
Fagenson AM, Pitt HA, Lau KN. Perioperative Blood Transfusions or Operative Time: Which Drives Post-Hepatectomy Outcomes? Am Surg 2021; 88:1644-1652. [PMID: 33705247 DOI: 10.1177/0003134821998666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Perioperative blood transfusions and operative time are surgical quality indicators. The aim of this analysis is to determine which of these variables drives post-hepatectomy outcomes. METHODS Patients undergoing major or partial hepatectomy were identified in the 2014-2018 American College of Surgeons National Surgical Quality Improvement Program hepatectomy targeted database. Prolonged operative time was defined as ≥ 240 minutes. Multivariable logistic regressions were performed for multiple postoperative outcomes. RESULTS Of 20 521 hepatectomies, 18% of patients received a perioperative transfusion, and the median operative time was 218 minutes. Patients receiving a transfusion had a significant (P < .001) increase in mortality (5.1% vs. .7%) and serious morbidity (43% vs. 16%). Prolonged operative time was associated with significantly (P < .001) increased mortality (2.4% vs. .8%) and serious morbidity (29% vs. 14%). Those with primary hepatobiliary cancer had the highest rates of postoperative morbidity and mortality compared to patients with metastatic and benign disease when a transfusion occurred. On multivariable regression analyses, perioperative transfusions conferred a higher risk (P < .001) than prolonged operative time for mortality (OR 5.02 vs. 1.47) and serious morbidity (OR 2.56 vs. 1.50). CONCLUSIONS Perioperative blood transfusions are a more robust predictor of post-hepatectomy outcomes than increased operative time, especially in patients with primary hepatobiliary cancer.
Collapse
Affiliation(s)
- Alexander M Fagenson
- Department of Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Henry A Pitt
- 145249Rutgers Cancer Institute of New Jersey, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Kwan N Lau
- Department of Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| |
Collapse
|
9
|
Jiang Y, Karri J, Mathias K, Abd-Elsayed A. The Effects of Perioperative Transfusion of Allogenic Blood Products of Cancer Recurrence. ESSENTIALS OF BLOOD PRODUCT MANAGEMENT IN ANESTHESIA PRACTICE 2021:397-403. [DOI: 10.1007/978-3-030-59295-0_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
10
|
Improved postoperative outcomes and reduced transfusion rates after implementation of a Patient Blood Management program in gastric cancer surgery. Eur J Surg Oncol 2020; 47:1449-1457. [PMID: 33267997 DOI: 10.1016/j.ejso.2020.11.129] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/20/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Gastric cancer patients are often transfused with red blood cells, with negative impact on postoperative course. This multicenter prospective interventional cohort study aimed to determine whether implementation of a Patient Blood Management (PBM) program, was associated with a decrease in transfusion rate and improvements in clinical outcomes in gastric cancer surgery. METHODS We compared transfusion practices and clinical outcomes in patients undergoing elective gastric cancer resection before and after implementing a PBM program, including strategies to detect and treat anemia and restrictive transfusion practice (2014-2018). Primary outcome was transfusion rate (TR). Secondary outcomes were complications, reoperations, length of stay, readmissions, 90-day mortality and failure-to-rescue. Differences were adjusted by confounding factors. RESULTS Some 789 patients were included (496 pre- and 293 post-PBM). TR decreased from 39.1% to 27.0% (adjusted difference -9.1, 95% CI -15.2 to -2.9), being reduction particularly significant in patients with anemia, ASA score 3-4, locally advanced tumors, undergoing open surgery and total gastrectomy. Infectious complications diminished from 25% to 16.4% (-6.1, 95%CI -11.5 to -0.7), reoperations from 8.1% to 6.1% (-2.2, 95%CI -5.1 to +0.6), median length of stay from 11 [IQR 8-18] to 8 [7-12] days (p < 0.001), hospital readmission from 14.1% to 8.9% (-5.4, 95%CI -9.6 to -1.1), mortality from 7.9% to 4.8% (-2.4, 95%CI -4.7 to -0.01), and failure-to rescue from 62.7% to 32.7% (-23.1, 95%CI -37.7 to -8.5). CONCLUSION Implementation of a PBM program was associated with a reduction in transfusion rate and improvement in postoperative outcomes in gastric cancer patients undergoing curative resection.
Collapse
|
11
|
Lee J, An JY, Choi MG, Park SH, Kim ST, Lee JH, Sohn TS, Bae JM, Kim S, Lee H, Min BH, Kim JJ, Jeong WK, Choi DI, Kim KM, Kang WK, Kim M, Seo SW. Deep Learning-Based Survival Analysis Identified Associations Between Molecular Subtype and Optimal Adjuvant Treatment of Patients With Gastric Cancer. JCO Clin Cancer Inform 2019; 2:1-14. [PMID: 30652558 PMCID: PMC6873983 DOI: 10.1200/cci.17.00065] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Gastric cancer (GC) is the third-leading cause of cancer-related deaths. Several pivotal clinical trials of adjuvant treatments were performed during the previous decade; however, the optimal regimen for adjuvant treatment of GC remains controversial. Patients and Methods We developed a novel deep learning–based survival model (survival recurrent network [SRN]) in patients with GC by including all available clinical and pathologic data and treatment regimens. This model uses time-sequential data only in the training step, and upon being trained, it receives the initial data from the first visit and then sequentially predicts the outcome at each time point until it reaches 5 years. In total, 1,190 patients from three cohorts (the Asian Cancer Research Group cohort, n = 300; the fluorouracil, leucovorin, and radiotherapy cohort, n = 432; and the Adjuvant Chemoradiation Therapy in Stomach Cancer cohort, n = 458) were included in the analysis. In addition, we added Asian Cancer Research Group molecular classifications into the prediction model. SRN simulated the sequential learning process of clinicians in the outpatient clinic using a recurrent neural network and time-sequential outcome data. Results The mean area under the receiver operating characteristics curve was 0.92 ± 0.049 at the fifth year. The SRN demonstrated that GC with a mesenchymal subtype should elicit a more risk-adapted postoperative treatment strategy as a result of its high recurrence rate. In addition, the SRN found that GCs with microsatellite instability and GCs of the papillary type exhibited significantly more favorable survival outcomes after capecitabine plus cisplatin chemotherapy alone. Conclusion Our SRN predicted survival at a high rate, reaching 92% at postoperative year 5. Our findings suggest that SRN-based clinical trials or risk-adapted adjuvant trials could be considered for patients with GC to investigate more individualized adjuvant treatments after curative gastrectomy.
Collapse
Affiliation(s)
- Jeeyun Lee
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Ji Yeong An
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Min Gew Choi
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Se Hoon Park
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Seung Tae Kim
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Jun Ho Lee
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Tae Sung Sohn
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Jae Moon Bae
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Sung Kim
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Hyuk Lee
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Byung-Hoon Min
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Jae J Kim
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Woo Kyoung Jeong
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Dong-Il Choi
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Kyoung-Mee Kim
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Won Ki Kang
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Mijung Kim
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| | - Sung Wook Seo
- Jeeyun Lee, Ji Yeong An, Min Gew Choi, Se Hoon Park, Seung Tae Kim, Jun Ho Lee, Tae Sung Sohn, Jae Moon Bae, Sung Kim, Hyuk Lee, Byung-Hoon Min, Jae J. Kim, Woo Kyoung Jeong, Dong-Il Choi, Kyoung-Mee Kim, Won Ki Kang, and Sung Wook Seo, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and Mijung Kim, Ghent University, Ghent, Belgium
| |
Collapse
|
12
|
Nakanishi K, Kanda M, Kodera Y. Long-lasting discussion: Adverse effects of intraoperative blood loss and allogeneic transfusion on prognosis of patients with gastric cancer. World J Gastroenterol 2019; 25:2743-2751. [PMID: 31235997 PMCID: PMC6580348 DOI: 10.3748/wjg.v25.i22.2743] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 03/29/2019] [Accepted: 04/20/2019] [Indexed: 02/06/2023] Open
Abstract
Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients’ prognosis.
Collapse
Affiliation(s)
- Koki Nakanishi
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| |
Collapse
|
13
|
Cost analysis of oral and maxillofacial free flap reconstruction for patients at an institution in China. Int J Oral Maxillofac Surg 2019; 48:590-596. [DOI: 10.1016/j.ijom.2018.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/14/2018] [Accepted: 10/29/2018] [Indexed: 12/17/2022]
|
14
|
Quiram BJ, Crippa J, Grass F, Lovely JK, Behm KT, Colibaseanu DT, Merchea A, Kelley SR, Harmsen WS, Larson DW. Impact of enhanced recovery on oncological outcomes following minimally invasive surgery for rectal cancer. Br J Surg 2019; 106:922-929. [PMID: 30861099 DOI: 10.1002/bjs.11131] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/18/2018] [Accepted: 01/15/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Oncological outcomes of locally advanced rectal cancer depend on the quality of surgical and oncological management. Enhanced recovery pathways (ERPs) have yet to be assessed for their oncological impact when used in combination with minimally invasive surgery. This study assessed outcomes with or without an ERP in patients with rectal cancer. METHODS This was a retrospective analysis of all consecutive adult patients who underwent elective minimally invasive surgery for primary rectal adenocarcinoma with curative intent between February 2005 and April 2018. Both laparoscopic and robotic procedures were included. Short-term morbidity and overall survival were compared between patients treated according to the institutional ERP and those who received conventional care. RESULTS A total of 600 patients underwent minimally invasive surgery, of whom 320 (53·3 per cent) were treated according to the ERP and 280 (46·7 per cent) received conventional care. ERP was associated with less overall morbidity (34·7 versus 54·3 per cent; P < 0·001). Patients in the ERP group had improved overall survival on univariable (91·4 versus 81·7 per cent at 5 years; hazard ratio (HR) 0·53, 95 per cent c.i. 0·28 to 0·99) but not multivariable (HR 0·78, 0·41 to 1·50) analysis. Multivariable analysis revealed age (HR 1·46, 1·17 to 1·82), male sex (HR 1·98, 1·05 to 3·70) and complications (HR 2·23, 1·30 to 3·83) as independent risk factors for compromised overall survival. Disease-free survival was comparable for patients who had ERP or conventional treatment (80·5 versus 84·6 per cent at 5 years respectively; P = 0·272). CONCLUSION Treatment within an ERP was associated with a lower morbidity risk that may have had a subtle impact on overall but not disease-specific survival.
Collapse
Affiliation(s)
- B J Quiram
- St Olaf College, Northfield, Minnesota, USA
| | - J Crippa
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - F Grass
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - J K Lovely
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA
| | - K T Behm
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - D T Colibaseanu
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - A Merchea
- Mayo Clinic Pharmacy, Mayo Clinic, Rochester, Minnesota, USA.,Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - S R Kelley
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - W S Harmsen
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - D W Larson
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
15
|
Bensignor T, Lefevre JH, Creavin B, Chafai N, Lescot T, Hor T, Debove C, Paye F, Balladur P, Tiret E, Parc Y. Postoperative Peritonitis After Digestive Tract Surgery: Surgical Management and Risk Factors for Morbidity and Mortality, a Cohort of 191 Patients. World J Surg 2018; 42:3589-3598. [PMID: 29850950 DOI: 10.1007/s00268-018-4687-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Postoperative peritonitis (POP) following gastrointestinal surgery is associated with significant morbidity and mortality, with no clear management option proposed. The aim of this study was to report our surgical management of POP and identify pre- and perioperative risk factors for morbidity and mortality. METHODS All patients with POP undergoing relaparotomy in our department between January 2004 and December 2013 were included. Pre- and perioperative data were analyzed to identify predictors of morbidity and mortality. RESULTS A total of 191 patients required relaparotomy for POP, of which 16.8% required >1 reinterventions. The commonest cause of POP was anastomotic leakage (66.5%) followed by perforation (20.9%). POP was mostly treated by anastomotic takedown (51.8%), suture with derivative stoma (11.5%), enteral resection and stoma (12%), drainage of the leak (8.9%), stoma on perforation (8.4%), duodenal intubation (7.3%) or intubation of the leak (3.1%). The overall mortality rate was 14%, of which 40% died within the first 48 h. Major complications (Dindo-Clavien > 2) were seen in 47% of the cohort. Stoma formation occurred in 81.6% of patients following relaparotomy. Independent risk factors for mortality were: ASA > 2 (OR = 2.75, 95% CI = 1.07-7.62, p = 0.037), multiorgan failure (MOF) (OR = 5.22, 95% CI = 2.11-13.5, p = 0.0037), perioperative transfusion (OR = 2.7, 95% CI = 1.05-7.47, p = 0.04) and upper GI origin (OR = 3.55, 95% CI = 1.32-9.56, p = 0.013). Independent risk factors for morbidity were: MOF (OR = 2.74, 95% CI = 1.26-6.19, p = 0.013), upper GI origin (OR = 3.74, 95% CI = 1.59-9.44, p = 0.0034) and delayed extubation (OR = 0.27, 95% CI = 0.14-0.55, p = 0.0027). CONCLUSION Mortality following POP remains a significant issue; however, it is decreasing due to effective and aggressive surgical intervention. Predictors of poor outcomes will help tailor management options.
Collapse
Affiliation(s)
- Thierry Bensignor
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Jérémie H Lefevre
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.
| | - Ben Creavin
- Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Najim Chafai
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Thomas Lescot
- Department of Surgical Intensive Care, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 75012, Paris, France
| | - Thévy Hor
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Clotilde Debove
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - François Paye
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Pierre Balladur
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Emmanuel Tiret
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Yann Parc
- Department of General and Digestive Surgery, Hôpital Saint-Antoine, Assistance Publique Hôpitaux de Paris, Sorbonne Université, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| |
Collapse
|
16
|
|
17
|
Liu X, Ma M, Huang H, Wang Y. Effect of perioperative blood transfusion on prognosis of patients with gastric cancer: a retrospective analysis of a single center database. BMC Cancer 2018; 18:649. [PMID: 29890957 PMCID: PMC5996555 DOI: 10.1186/s12885-018-4574-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 06/01/2018] [Indexed: 01/17/2023] Open
Abstract
Background The association between perioperative blood transfusion and the prognosis of patients with gastric cancer is still unclear. Methods A total of 1581 patients with gastric cancer who underwent curative gastrectomy from 2000 to 2008 were evaluated. Perioperative blood transfusion was defined as the transfusion of packed red blood cells within seven days before surgery, during surgery, or within the postoperative hospitalization period. The association between perioperative blood transfusion and prognosis was evaluated using univariate and multivariate Cox regression analyses. Results Of 1581 patients, 298 patients (19%) received perioperative blood transfusion. Perioperative blood transfusion correlated with older age (P < 0.001); larger tumor size (P < 0.001); and more advanced stage (P < 0.001). Five-year survival rate was 40% in patients who had perioperative blood transfusion and 55% patients who did not have perioperative blood transfusion, and the difference was statistically significant (P < 0.001). Multivariate analysis showed that perioperative blood transfusion was defined as independent prognostic factor. Perioperative blood transfusion was associated with worse outcomes in patients with stage III (P < 0.001). Conclusions Perioperative blood transfusion independently correlated with poorer prognosis in patients with gastric cancer.
Collapse
Affiliation(s)
- Xiaowen Liu
- Department of Gastric Cancer Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Mingze Ma
- Department of Gastric Cancer Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Hua Huang
- Department of Gastric Cancer Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, People's Republic of China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yanong Wang
- Department of Gastric Cancer Surgery, Fudan University Shanghai Cancer Center, 270 Dong An Road, Shanghai, 200032, People's Republic of China. .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
18
|
Restrictive Transfusion Practices After Esophagectomy Are Associated With Improved Outcome. Ann Surg 2018; 267:886-891. [DOI: 10.1097/sla.0000000000002231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
19
|
The prognostic role of perioperative allogeneic blood transfusions in gastric cancer patients undergoing curative resection: A systematic review and meta-analysis of non-randomized, adjusted studies. Eur J Surg Oncol 2018; 44:404-419. [PMID: 29398320 DOI: 10.1016/j.ejso.2018.01.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 08/25/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022] Open
Abstract
The impact of allogeneic perioperative blood transfusions (APTs) on the prognosis of gastric cancer patients undergoing curative-intent gastrectomy is still a highly debated topic. Two meta-analyses were published in 2015, and new studies report conflicting results. A literature review was conducted using PubMed, Scopus, the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews, updated to March 1, 2016. Thirty-eight non-randomized studies reporting data on overall survival (OS), disease-free survival (DFS), disease-specific survival (DSS) and postoperative complications (PCs) were included. An inverse variance random-effects meta-analysis was conducted. APTs showed an association with worse OS, DFS, DSS and an increased number of PCs. The hazard ratio (HR) for OS was 1.49, with a 95% confidence interval (95% CI) of 1.32-1.69 (p < .00001; Q-test p = .001, I-squared = 56%). After outlier exclusion, the HR for OS was 1.34 (95% CI = 1.23-1.45, p < .00001; Q-test p = .64, I-squared = 0%). The HR for DFS was 1.48 (95% CI = 1.18-1.86, p = .0007; Q-test p = .31, I-squared = 16%), and the HR for DSS was 1.66 (95% CI = 1.5-2.19, p = .0004; Q-test p = .96, I-squared = 0%). The odds ratio for PCs was 3.33 (95% CI = 2.10-5.29, p < .00001; Q-test p = .14, I-squared = 42%). This meta-analysis showed a significant association between transfusions and OS, DFS, DSS and PCs. The quality of the evidence was low. Aggregation, selection and selective reporting bias were detected. The biases shifted the results towards significance. Further studies using accurate adjustment methods are needed. Until such additional studies are performed, caution in administering transfusions and optimization of cancer patient blood management are warranted.
Collapse
|
20
|
Xiao H, Liu W, Quan H, Ouyang Y. Peri-Operative Blood Transfusion Does Not Influence Overall and Disease-Free Survival After Radical Gastrectomy for Stage II/III Gastric Cancer: a Propensity Score Matching Analysis. J Gastrointest Surg 2018; 22:1489-1500. [PMID: 29777453 PMCID: PMC6132396 DOI: 10.1007/s11605-018-3808-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/07/2018] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Whether peri-operative blood transfusions (BTF) negatively impact long-term survival after gastrectomy for gastric cancer (GC) remains controversial. The aim of this retrospective study was to investigate independent predictive factors of BTF and the potential impact of BTF on overall survival (OS) and disease-free survival (DFS) in patients who underwent radical gastrectomy for stage II/III GC. METHODS Of 1020 patients who underwent gastrectomy for stage II/III GC from November 2010 to December 2015, 231 (22.6%) patients received BTF. The independent predictive factors of BTF were identified using univariate and multivariate analyses. Cox regression and propensity score matching (PSM) analyses of OS and DFS in patients who received BTF or not were compared. RESULTS Multivariate analysis revealed that age, pre-operative hemoglobin levels, tumor size, operation time, combined multi-organ resection, and intra-operative blood loss were independent predictive factors for BTF. PSM analysis created 205 pairs of patients. BTF was significantly associated with decreased OS (P = 0.025) and DFS (P = 0.034) in the entire cohort before PSM. After PSM, there was no longer a significant association between BTF and OS (P = 0.850) or DFS (P = 0.880). BTF was not identified as an independent risk factor for OS or DFS by multivariate Cox regression analysis. CONCLUSIONS The present study revealed that BTF did not influence OS and DFS after radical gastrectomy for stage II/III GC. Worse oncological outcomes were caused by clinical circumstances requiring blood transfusions, including longer operation time and advanced tumor stage, not due to BTF itself.
Collapse
Affiliation(s)
- Hua Xiao
- 0000 0001 0379 7164grid.216417.7Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Wu Liu
- 0000 0001 0379 7164grid.216417.7Department of Gastroenterology and Urology, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Hu Quan
- 0000 0001 0379 7164grid.216417.7Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Yongzhong Ouyang
- 0000 0001 0379 7164grid.216417.7Department of Gastroduodenal and Pancreatic Surgery, Hunan Cancer Hospital and the Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
21
|
Garona J, Sobol NT, Alonso DF. Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Colorectal Cancer: Potential use of Perioperative Desmopressin to Reduce Allogenic Blood Transfusion Rates. J Gastrointest Surg 2017; 21:1971-1973. [PMID: 28840437 DOI: 10.1007/s11605-017-3551-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 08/16/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Juan Garona
- Laboratory of Molecular Oncology, National University of Quilmes, R. Saenz Peña 352, Bernal, B1876BXD, Buenos Aires, Argentina.,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Natasha T Sobol
- Laboratory of Molecular Oncology, National University of Quilmes, R. Saenz Peña 352, Bernal, B1876BXD, Buenos Aires, Argentina
| | - Daniel F Alonso
- Laboratory of Molecular Oncology, National University of Quilmes, R. Saenz Peña 352, Bernal, B1876BXD, Buenos Aires, Argentina. .,National Council of Scientific and Technical Research (CONICET), Buenos Aires, Argentina.
| |
Collapse
|
22
|
Saxena A, Valle SJ, Liauw W, Morris DL. Allogenic Blood Transfusion Is an Independent Predictor of Poorer Peri-operative Outcomes and Reduced Long-Term Survival after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: a Review of 936 Cases. J Gastrointest Surg 2017; 21:1318-1327. [PMID: 28560703 DOI: 10.1007/s11605-017-3444-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 05/02/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION There is a paucity of data on the impact of allogenic blood transfusion (ABT) on morbidity and survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). METHODS Nine hundred and thirty-five consecutive CRS/HIPEC procedures were performed between 1996 and 2016 at a high-volume institution in Sydney, Australia. Of these, 337(36%) patients required massive ABT (MABT) (≥5 units). Peri-operative complications were graded according to the Clavien-Dindo classification. The association of concomitant MABT with 21 peri-operative outcomes and overall survival (OS) was assessed using univariate and multivariate analyses. RESULTS In-hospital mortality was 1.8%. Patients requiring MABT had more extensive disease as reflected by a higher peritoneal cancer index (≥17) (70 vs. 29%, p < 0.001) and longer operative times (≥9 h) (82 vs. 35%, p < 0.001). After accounting for confounding factors, MABT was associated with in-hospital mortality (relative risk (RR), 7.72; 95% confidence interval (CI), 1.35-10.11; p = 0.021) and grade III/IV morbidity (RR, 2.05; 95% CI, 1.42-2.95; p < 0.001). MABT was associated with an increased incidence of prolonged hospital stay (≥28 days) (RR, 1.86; 95% CI, 1.26-2.74; p = 0.002) and intensive care unit stay (≥4 days) (RR, 1.83; 95% CI, 1.24-2.70, p = 0.002). It was also associated with a significant OS in patients with colorectal cancer peritoneal carcinomatosis (RR 4.49; p < 0.001) and pseudomyxoma peritonei (RR, 4.37; p = 0.026), but not appendiceal cancer (p = 0.160). CONCLUSION MABT is an independent predictor for poorer peri-operative outcomes including in-hospital mortality and grade III/IV morbidity. It may also compromise long-term survival, particularly in patients with colorectal cancer peritoneal carcinomatosis.
Collapse
Affiliation(s)
- Akshat Saxena
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia.
| | - Sarah J Valle
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
| | - Winston Liauw
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
| | - David L Morris
- UNSW Department of Surgery, St George Hospital, Kogarah, New South Wales, Australia
| |
Collapse
|
23
|
Perioperative blood transfusion and the clinical outcomes of patients undergoing cholangiocarcinoma surgery: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2016; 28:1233-40. [PMID: 27560845 DOI: 10.1097/meg.0000000000000706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Several studies have reported different results on the association between perioperative blood transfusion (PBT) and clinical outcomes for patients undergoing cholangiocarcinoma surgery. So far, no systematic review and meta-analysis have focused on this inconsistent issue. Therefore, we carried out a systematic review and meta-analysis to evaluate the association between PBT and the clinical outcomes of cholangiocarcinoma surgery patients. EMBASE, PubMed, Web of Science, and the Cochrane Library were searched from their inception to 6 April 2016 to evaluate the relationship between PBT and clinical outcomes for patients undergoing cholangiocarcinoma surgery. The pooled hazard ratio (HR) with a 95% confidence interval (CI) was calculated using the Cochrane Collaboration's RevMan 5.3 software. A total of 10 studies (1719 patients) were included in the meta-analysis. Pooled analysis showed that PBT was associated with worse 5-year survival rate (HR=1.67, 95% CI=1.41-1.98, P<0.0001) and median overall survival (OS) (HR=1.45, 95% CI=1.14-1.83, P=0.002) in the patients who underwent cholangiocarcinoma surgery. Subgroup analysis showed that intraoperative blood transfusion was also associated with worse 5-year survival rate (HR=1.95, 95% CI=1.49-2.57, P<0.00001). Intraoperative blood transfusion is associated with poor OS for patients undergoing cholangiocarcinoma surgery because it will increase the risk of death. Postoperative blood transfusion may not be associated with OS. In addition, the relationship between PBT and the postoperative complication rate of cholangiocarcinoma surgery is still unclear.
Collapse
|
24
|
Wang SY, Lei GL, Sun JY, Liu J, Liu ZG. Effect of perioperative blood transfusion on postoperative complications after liver transplantation. Shijie Huaren Xiaohua Zazhi 2016; 24:1891-1897. [DOI: 10.11569/wcjd.v24.i12.1891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of perioperative blood transfusion on complications after liver transplantation.
METHODS: In order to analyze the relationship between blood transfusion and complications after liver transplantation, the clinical data for 418 patients who underwent liver transplantation from January 1, 2005 to December 31, 2012 at our hospital were analyzed retrospectively.
RESULTS: Of 386 liver transplantation patients, 235 (60.88%) developed postoperative complications and 151 (39.12%) did not occur. The main early complications were lung infection, electrolyte disturbance and reperfusion injury. As the frequency and amount of blood transfused increased, the incidence of complications increased.
CONCLUSION: The higher the frequency and amount of perioperative blood transfusion after liver transplantation, the higher the incidence of complications including infection, electrolyte imbalance, reperfusion injury and so on. Therefore, perioperative blood transfusion should be minimized.
Collapse
|