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Cho S, Park J, Lee M, Lee D, Choi H, Gim G, Kim L, Kang CY, Oh Y, Viveiros P, Vagia E, Oh MS, Cho GJ, Bharat A, Chae YK. Blood transfusions may adversely affect survival outcomes of patients with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2021; 10:1700-1710. [PMID: 34012786 PMCID: PMC8107741 DOI: 10.21037/tlcr-20-933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Background Despite common use in clinical practice, the impact of blood transfusions on prognosis among patients with lung cancer remains unclear. The purpose of the current study is to perform an updated systematic review and meta-analysis to evaluate the influence of blood transfusions on survival outcomes of lung cancer patients. Methods We searched PubMed, Embase, Cochrane Library, and Ovid MEDLINE for publications illustrating the association between blood transfusions and prognosis among people with lung cancer from inception to November 2019. Overall survival (OS) and disease-free survival (DFS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were computed using the random-effects model. Study heterogeneity was evaluated with the I2 test. Publication bias was explored via funnel plot and trim-and-fill analyses. Results We included 23 cohort studies with 12,175 patients (3,027 cases and 9,148 controls) for meta-analysis. Among these records, 22 studies investigated the effect of perioperative transfusions, while one examined that of transfusions during chemotherapy. Two studies suggested the possible dose-dependent effect in accordance with the number of transfused units. In pooled analyses, blood transfusions deleteriously influenced both OS (HR=1.35, 95% CI: 1.14–1.61, P<0.001, I2=0%) and DFS (HR=1.46, 95% CI: 1.15–1.86, P=0.001, I2=0%) of people with lung cancer. No evidence of significant publication bias was detected in funnel plot and trim-and-fill analyses (OS: HR=1.26, 95% CI: 1.07–1.49, P=0.006; DFS: HR=1.35, 95% CI: 1.08–1.69, P=0.008). Conclusions Blood transfusions were associated with decreased survival of patients with lung cancer.
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Affiliation(s)
- Sukjoo Cho
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jonghanne Park
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Misuk Lee
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongyup Lee
- Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA, USA
| | - Horyun Choi
- Department of Internal Medicine, University of Hawaii, Honolulu, HI, USA
| | - Gahyun Gim
- Department of Medicine, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Leeseul Kim
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Cyra Y Kang
- Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Youjin Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Pedro Viveiros
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elena Vagia
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael S Oh
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ankit Bharat
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Young Kwang Chae
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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2
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Tai YH, Wu HL, Mandell MS, Lin SP, Tsou MY, Chang KY. The association of non-small cell lung cancer recurrence with allogenic blood transfusion after surgical resection: A propensity score analysis of 1,803 patients. Eur J Cancer 2020; 140:45-54. [PMID: 33039813 DOI: 10.1016/j.ejca.2020.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Conflicting evidence underlies the controversial role of allogenic blood transfusion in recurrence of non-small cell lung cancer (NSCLC). Insufficient sample size and failure to measure effects of important confounders in previous studies contribute to the conflicting findings. To overcome these limitations, we applied robust statistics and weighted covariates in a large study cohort. METHODS Cox regression analyses were used to estimate the recurrence and survival in patients with NSCLC disease stages I through III who were transfused for a haemoglobin level less than 8.0 g/dL within seven days after surgical resection. Inverse probability of treatment weighting (IPTW) was used to balance covariates in the sequential cohort of patients receiving an incremental amount of blood. We applied restricted cubic spline functions to characterise dose-response effects of transfusion amount on recurrence and mortality. RESULTS A total of 209 (11.6%) of 1803 patients received transfusions. Over a median of 42 months after surgery (interquartile range 24.9-71.9), patients who received blood had a greater risk of early recurrence (IPTW-adjusted HR: 1.81, 95% CI: 1.59-2.06, P < 0.001) and all-cause mortality (IPTW-adjusted hazard ratio, HR: 2.38, 95% CI: 1.97-2.87, P < 0.001). A non-linear dose-response occurred between transfusion amount and recurrence or mortality. CONCLUSIONS The greater risk of disease recurrence and early mortality after surgical resection in NSCLC patients who receive blood transfusion supports use of clinical strategies to reduce exposure. Further studies are needed to identify benchmarks to guide evidence-based practices.
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Affiliation(s)
- Ying-Hsuan Tai
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Anaesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Anaesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiang-Ling Wu
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mercedes Susan Mandell
- Department of Anaesthesiology, University of Colorado Health Sciences Centre, Aurora, CO, United States
| | - Shih-Pin Lin
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Mei-Yung Tsou
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuang-Yi Chang
- Department of Anaesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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3
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Kidane B, Jacob N, Bruinooge A, Shen YC, Keshavjee S, dePerrot ME, Pierre AF, Yasufuku K, Cypel M, Waddell TK, Darling GE. Postoperative but not intraoperative transfusions are associated with respiratory failure after pneumonectomy. Eur J Cardiothorac Surg 2020; 58:1004-1009. [DOI: 10.1093/ejcts/ezaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/17/2023] Open
Abstract
Abstract
OBJECTIVES
Transfusion of blood products has been associated with increased risk of post-pneumonectomy respiratory failure. It is unclear whether intraoperative or postoperative transfusions confer a higher risk of respiratory failure. Our objective was to assess the role of transfusions in developing post-pneumonectomy respiratory failure.
METHODS
We performed a retrospective cohort study using prospectively collected data on consecutive pneumonectomies between 2005 and 2015. Patient records were reviewed for intraoperative/postoperative exposures. Univariable and multivariable analyses were performed.
RESULTS
Of the 251 pneumonectomies performed during the study period, 24 (9.6%) patients suffered respiratory failure. Ninety-day mortality was 5.6% (n = 14) and was more likely in patients with respiratory failure (7/24 vs 7/227, P < 0.001). Intraoperative and postoperative transfusions occurred in 42.2% (n = 106) and 44.6% (n = 112) of patients, respectively and were predominantly red blood cells. On univariable analysis, both intraoperative (P = 0.03) and postoperative transfusion (P = 0.004) were associated with a higher risk of respiratory failure. The multivariable model significantly predicted respiratory failure with an area under curve (AUC) = 0.88 (P = 0.001). On multivariable analysis, the only independent predictors of respiratory failure were postoperative transfusions [adjusted odds ratio (aOR) 6.54, 95% confidence interval (CI) 1.74–24.59; P = 0.005] and lower preoperative forced expiratory volume (adjusted OR 0.96, 95% CI 0.93–0.99; P = 0.03). Estimated blood loss was not significantly different (P = 0.91) between those with (median 800 ml, interquartile range 300–2000 ml) and without respiratory failure (median 800 ml, interquartile range 300–2000 ml).
CONCLUSIONS
Respiratory failure occurred in 9.6% of patients post-pneumonectomy and confers a higher risk of 90-day mortality. Postoperative (but not intraoperative) transfusion was the strongest independent predictor associated with respiratory failure. Intraoperative transfusion may be in reaction to active/unpredictable blood loss and may not be easily modifiable. However, postoperative transfusion may be modifiable and potentially avoidable. Transfusion thresholds should be assessed in light of potential cost-benefit trade-offs.
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Affiliation(s)
- Biniam Kidane
- Department of Surgery, Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Nithin Jacob
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Allan Bruinooge
- Department of Surgery, Section of Thoracic Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Yu Cindy Shen
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Shaf Keshavjee
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Marc E dePerrot
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Andrew F Pierre
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Kazuhiro Yasufuku
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Marcelo Cypel
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Thomas K Waddell
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Gail E Darling
- Department of Surgery, Division of Thoracic Surgery, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
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4
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Sallam AA, Abo El Nasr MM, Elgebaly AS, El Feky WM. The use of tranexamic acid in elective lung surgery: a single-center experience. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2019. [DOI: 10.4103/ejb.ejb_29_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Rolli L, Duranti L, Leuzzi G. Treatment of anaemia in the "ERAS" era: how far can we go? J Thorac Dis 2019; 11:3692-3695. [PMID: 31656640 DOI: 10.21037/jtd.2019.09.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Luigi Rolli
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Leonardo Duranti
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
| | - Giovanni Leuzzi
- Division of Thoracic Surgery, IRCCS Istituto Nazionale dei Tumori Foundation, Milan, Italy
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Sakin A, Sahin S, Yasar N, Demir C, Arici S, Geredeli C, Cihan S. Prognostic impact of blood transfusion in patients with metastatic non-small cell lung cancer receiving chemotherapy. Lung Cancer 2019; 133:38-44. [PMID: 31200825 DOI: 10.1016/j.lungcan.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate the prognostic effects of Allogeneic Blood Transfusion (ABT) in patients with metastatic Non-Small Cell Lung Cancer (NSCLC) receiving Chemotherapy (CT) in the first-line treatment, comparing untransfused patients to those receiving blood transfusion during treatment period or before treatment period. METHODS This was a retrospective study of 433 patients with metastatic NSCLC receiving CT in the first-line treatment. Patients were categorized into 3 groups according to the transfusion strategy as follows; group-U(Untransfused patients, n = 303), group-B(patients receiving transfusion Before treatment period, n = 43), and group-D(patients receiving transfusion During treatment period, n = 87). RESULTS There were 433 patients in the analysis, consisting of 388 (89.6%) males, with a median age of 60 years(range, 21-92). The median Overall Survival(mOS) according to the ABT was 14 months for group-U, 9 months for group-B, and 7 months for group-D (p < 0.001). In subgroup analysis, patients with squamous cell carcinoma subtype, mOS was 11 months for group-U, 12 months for group-B, and 9 month for group-D (p = 0.074) The corresponding mOS durations for adenocarcinoma subtype were 21 months, 7 months, and 6 months (p < 0.001). Performing ABT during treatment period was found to be a negative independent factor related to OS (HR 1.50 for progression-free survival, 95% CI 1.15-1.97, HR 1.36 for OS, 95% CI 1.04-1.80). CONCLUSION Our results demonstrated that ABT was significantly associated with earlier progression and shorter survival in patients with metastatic NSCLC, especially in adenocarcinoma histology, hence suggesting that transfusion strategy in this group should remain limited, and its benefit should outweigh the risk of progression.
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Affiliation(s)
- Abdullah Sakin
- Yuzuncu Yil University Faculty of Medicine, Medical Oncology Department, 65030, Van, Turkey.
| | - Suleyman Sahin
- University of health Sciences, Van Research and Training Hospital, Medical Oncology Department, Van, Turkey.
| | - Nurgul Yasar
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - Cumhur Demir
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - Serdar Arici
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - Caglayan Geredeli
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
| | - Sener Cihan
- Department of Medical Oncology, University of Health Sciences, Okmeydani Training and Research Hospital, 34384, Istanbul, Turkey.
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8
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Latif MJ, Tan KS, Molena D, Huang J, Bott MJ, Park BJ, Adusumilli PS, Rusch VW, Bains MS, Downey RJ, Jones DR, Isbell JM. Perioperative blood transfusion has a dose-dependent relationship with disease recurrence and survival in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg 2019; 157:2469-2477.e10. [PMID: 30902468 DOI: 10.1016/j.jtcvs.2018.12.109] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/04/2018] [Accepted: 12/21/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Perioperative blood transfusions have been implicated in decreased overall survival (OS) and disease-free survival (DFS) after resection for non-small cell lung cancer (NSCLC). We investigated the effects of single- and multiple-unit blood transfusions on OS, DFS, and recurrence after anatomic pulmonary resection. METHODS From January 1, 2000, to June 30, 2016, 5709 consecutive patients underwent pulmonary resection for NSCLC at our institution. Exclusion criteria were stage IIIB-IV disease, incomplete resections, ill-defined histologic subtypes, and nonanatomic wedge resections. For the 0 versus single-unit analysis, propensity scores were calculated from a logistic regression model that predicted the probability of patients receiving a single-unit transfusion. The resulting matching weights were incorporated into Cox models for OS, DFS, and cumulative incidence of recurrence, to compare no versus single-unit blood transfusion. We determined whether increasing numbers of blood transfusions influenced survival or recurrence using multivariable Cox models. RESULTS Approximately 10% of patients received perioperative blood transfusion (median follow-up, 7.46 years [25th-75th percentile, 3.98-11.8]). There was no difference in OS, DFS, or cumulative incidence of recurrence between patients receiving no transfusion and those receiving single-unit transfusion (P > .05). However, a dose-response relationship was observed, demonstrating worse OS (overall P < .001), DFS (overall P < .001), and recurrence (overall P = .010) with increasing units of blood transfused. CONCLUSIONS Although a single-unit blood transfusion did not affect survival in patients undergoing resection for NSCLC, greater unit perioperative blood transfusions were associated with significantly decreased long-term outcomes in a dose-dependent manner, suggesting avoidance or minimization of transfusions could improve long-term survival after lung resection.
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Affiliation(s)
- M Jawad Latif
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniela Molena
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James Huang
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Matthew J Bott
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Bernard J Park
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Prasad S Adusumilli
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie W Rusch
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Manjit S Bains
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert J Downey
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David R Jones
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James M Isbell
- Thoracic Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
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9
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Lyu X, Qiao W, Li D, Leng Y. Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis. Oncotarget 2018; 8:41740-41748. [PMID: 28410243 PMCID: PMC5522331 DOI: 10.18632/oncotarget.16771] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/09/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Perioperative blood transfusion may be associated with negative clinical outcomes in oncological surgery. A meta-analysis of published studies was conducted to evaluate the impact of blood transfusion on short- and long-term outcomes following liver resection of colorectal liver metastasis (CLM). MATERIALS AND METHODS A systematic search was performed to identify relevant articles. Data were pooled for meta-analysis using Review Manager version 5.3. RESULTS Twenty-five observational studies containing 10621 patients were subjected to the analysis. Compared with non-transfused patients, transfused patients experienced higher overall morbidity (odds ratio [OR], 1.98; 95% confidence intervals [CI] =1.49-2.33), more major complications (OR, 2.12; 95% CI =1.26-3.58), higher mortality (OR, 4.13; 95% CI =1.96-8.72), and longer length of hospital stay (weighted mean difference, 4.43; 95% CI =1.15-7.69). Transfusion was associated with reduced overall survival (risk ratio [RR], 1.24, 95% CI =1.11-1.38) and disease-free survival (RR, 1.38, 95% CI=1.23-1.56). CONCLUSION Perioperative blood transfusion has a detrimental impact on the clinical outcomes of patients undergoing CLM resection.
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Affiliation(s)
- Xinghua Lyu
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Wenhui Qiao
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Debang Li
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Yufang Leng
- Department of Anaesthesiology, The First Hospital of Lanzhou University, Lanzhou, China
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10
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Kidane B, Plourde M, Leydier L, Chadi SA, Eckert K, Srinathan S, Fortin D, Frechette E, Inculet RI, Malthaner RA. RBC transfusion is associated with increased risk of respiratory failure after pneumonectomy. J Surg Oncol 2017; 115:435-441. [PMID: 28334418 DOI: 10.1002/jso.24548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/14/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES Pneumonectomy is associated with high risk of respiratory complications. Our objective was to determine if transfusions are associated with increased rate of ARDS and respiratory failure in adults undergoing elective pneumonectomy. METHODS Retrospective cohort study of consecutive pneumonectomies undertaken at a tertiary hospital (2003-2013). Multivariable logistic regression was performed to adjust for confounding factors. RESULTS ARDS and respiratory failure occurred in 12.4% (n = 20) and 19.2% (n = 31) of 161 pneumonectomy patients, respectively, and were more likely to occur in transfused patients (P = 0.03, P < 0.001). pRBCs, FFP and platelets were transfused in 27% (n = 43), 6% (n = 9), and 2% (n = 3), respectively. On multivariable analyses utilizing blood products as continuous and binary variables, pRBC use was the only independent predictor of ARDS with odds ratio (OR) = 1.23 (95%CI:1.08-1.39, P = 0.002) and OR = 2.45 (95%CI:1.10-5.49, P = 0.03), respectively. On multivariable analyses utilizing blood products as continuous and binary variables, pRBCs were the only independent predictor of respiratory failure with OR = 1.37 (95%CI:1.16-1.60, P < 0.001) and OR = 3.17 (95%CI:1.25-8.02, P = 0.02), respectively. CONCLUSIONS Peri-operative pRBC use appears to be an independent risk factor for ARDS and respiratory failure after pneumonectomy. There is a significant dose-response relationship. Platelets and FFP did not appear to increase ARDS risk but this may be due to low utilization.
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Affiliation(s)
- Biniam Kidane
- Division of General Surgery, Department of Surgery, Western University, London, Canada.,Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.,University of Manitoba, Winnipeg, Canada
| | - Madelaine Plourde
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada
| | - Larissa Leydier
- Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.,University of Manitoba, Winnipeg, Canada
| | - Sami A Chadi
- Division of General Surgery, Department of Surgery, Western University, London, Canada
| | | | - Sadeesh Srinathan
- Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.,University of Manitoba, Winnipeg, Canada
| | - Dalilah Fortin
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.,London Health Sciences Centre, London, Canada.,Division of Critical Care Medicine, Western University, London, Canada
| | - Eric Frechette
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.,London Health Sciences Centre, London, Canada
| | - Richard I Inculet
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.,London Health Sciences Centre, London, Canada
| | - Richard A Malthaner
- Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.,London Health Sciences Centre, London, Canada
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11
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Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surg 2014; 14:34. [PMID: 24884867 PMCID: PMC4057617 DOI: 10.1186/1471-2482-14-34] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/19/2014] [Indexed: 01/02/2023] Open
Abstract
Background It is speculated that blood transfusion may induce adverse consequences after cancer surgery due to immunosuppression. This study was intended to assess the impact of perioperative blood transfusion on the prognosis of patients who underwent lung cancer resection. Methods Eligible studies were identified through a computerized literature search. The pooled relative risk ratio (RR) with 95% confidence interval (CI) was calculated using Review Manager 5.1 Software. Results Eighteen studies with a total of 5915 participants were included for this meta-analysis. Pooled analysis showed that perioperative blood transfusion was associated with worse overall survival (RR: 1.25, 95% CI: 1.13-1.38; P <0.001) and recurrence-free survival (RR: 1.42, 95% CI: 1.20-1.67; P <0.001) in patients with resected lung cancer. Conclusions Perioperative blood transfusion appears be associated with a worse prognosis in patients undergoing lung cancer resection. These data highlight the importance of minimizing blood transfusion during surgery.
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Affiliation(s)
| | | | | | - Yanming Zhou
- Department of Hepatobiliary & Pancreatovascular Surgery, Oncologic Center of Xiamen; First affiliated Hospital of Xiamen University, Xiamen 361003, China.
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12
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Wang T, Luo L, Huang H, Yu J, Pan C, Cai X, Hu B, Yin X. Perioperative Blood Transfusion Is Associated With Worse Clinical Outcomes in Resected Lung Cancer. Ann Thorac Surg 2014; 97:1827-37. [DOI: 10.1016/j.athoracsur.2013.12.044] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 12/02/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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13
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Cata JP, Chukka V, Wang H, Feng L, Gottumukkala V, Martinez F, Vaporciyan AA. Perioperative blood transfusions and survival in patients with non-small cell lung cancer: a retrospective study. BMC Anesthesiol 2013; 13:42. [PMID: 24228905 PMCID: PMC3832885 DOI: 10.1186/1471-2253-13-42] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 11/13/2013] [Indexed: 01/11/2023] Open
Abstract
Background Perioperative blood transfusions have been associated with poor clinical outcomes in the context of oncological surgery. Current literature is inconclusive whether blood transfusions are linked to shorter recurrence free and overall survival after lung cancer surgery. We hypothesize that blood transfusions in patients undergoing surgery for non-small cell lung cancer are associated with poor oncological survival. Methods After IRB approval, perioperative data from 636 patients who underwent lung cancer surgery was collected. Patients were evaluated for time to tumor recurrence and overall survival. Results 60 patients were transfused and 576 subjects were not. Patients who received transfusion were more likely to have more advanced disease (p = 0.018), and preoperative low hemoglobin concentrations (p < 0.0001) compared to non-transfused patients. In the multivariable Cox regression analysis, blood transfusion was associated with a significant reduction in recurrence free survival (p = 0.025), HR: 1.55 (95% CI: 1.06-2.27) and overall survival (p = 0.0002) HR: 2.04 (95% CI: 1.41-2.97). However, analysis after propensity score matching between the two groups revealed that the effect of blood transfusion was significant for reduction in overall survival (p = 0.0356), HR: 1.838 (95% CI: 1.04-3.22) but not for recurrence free survival (p = 0.1460), HR: 1.493 (95% CI: 0.87-2.56). Conclusions Perioperative administration of red blood cells appears be associated with a decreased overall survival but not recurrence free survival after lung cancer surgery. Our study has the limitations of a retrospective review. Hence, our results should be confirmed by a prospective randomized control trial.
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Affiliation(s)
- Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, USA.
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Completion pneumonectomy in patients with cancer: postoperative survival and mortality factors. J Thorac Oncol 2013; 7:1556-62. [PMID: 22982656 DOI: 10.1097/jto.0b013e31826419d2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe postoperative complications and long-term outcomes of completion pneumonectomy and highlight prognostic factors. METHOD We retrospectively reviewed the records of 46 patients (38 men, 8 women) who underwent completion pneumonectomy for lung cancer between 1995 and 2009 in one of two thoracic surgery departments. Most were current or former smokers (n = 41; 89%) and did not undergo chemotherapy (n = 38; 83%) or radiotherapy (83%) before surgery. RESULTS Complications after surgery were respiratory failure (n = 11; 24.4%), bronchopleural fistula (n = 6; 13%, with no side preference), and empyema (n = 6; 13%). Blood transfusion was necessary for 43% of the cases (n = 20). The day 90 death rate was 15.2% (n = 7). Postoperative staging showed mostly limited disease. Ten patients (21.7%) underwent operation for a second primary cancer, 25 for local recurrence (54.3%), five for microscopically incomplete resection, and six for other reasons. Median overall survival after completion surgery was 30 months (median follow-up: 46.5 months). Among the 15 living patients (33%), 11 are free of disease (24%). In a Cox regression model, factors negatively influencing overall survival were: age older than 65 years (odds ratio [OR] = 2.47; p = 0.012), current smoker status (OR = 2.285; p = 0.033), postoperative pulmonary (OR = 5.144; p = 0.004), cardiac (OR = 3.404; p = 0.033), or parietal wound complications (OR = 5.439; p = 0.016). CONCLUSION Despite its increased postoperative complications and mortality compared with standard pneumonectomy, completion pneumonectomy offers encouraging long-term results. Five main factors seem predictive of shorter overall survival.
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Planquette B, Le Pimpec-Barthes F, Trinquart L, Meyer G, Riquet M, Sanchez O. Early respiratory acidosis is a new risk factor for pneumonia after lung resection. Interact Cardiovasc Thorac Surg 2011; 14:244-8. [PMID: 22184462 DOI: 10.1093/icvts/ivr115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Postoperative pneumonia (POP) is a life-threatening complication of lung resection (LR). Its risk factors, bacteriological profile and outcome are not well known. The aims of this study were to describe the outcome and causal bacteria and to identify risk factors for POP. We reviewed all cases admitted to intensive care after LR. Clinical parameters, operative and postoperative data were recorded. POP was suspected on the basis of fever, radiographic infiltrate, and either leucocytosis or purulent sputum. The diagnosis was confirmed by culture of a respiratory sample. Risk factors for POP were identified by univariate and multivariate analysis. We included 159 patients in this study. POP was diagnosed in 23 patients (14.4%) and was associated with a higher hospital mortality rate (30% versus 5%, P = 0.0007) and a longer hospital stay. Members of the Enterobacteriaceae and Pseudomonas species were the most frequently identified pathogens. Early respiratory acidosis (ERA; OR, 2.94; 95% CI, 1.1-8.1), blood transfusion (OR, 3.8; 95% CI, 1.1-13.1), bilobectomy (OR, 7.26; 95% CI, 1.2-43.1) and smoking history (OR, 1.84; 95% CI, 1.1-3) were identified as independent risk factors. ERA may be a risk factor for POP and could serve as a target for therapeutic interventions.
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Affiliation(s)
- Benjamin Planquette
- Department of Respiratory and Intensive Care, Université Paris Descartes, AP-HP, Paris, France.
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Churchhouse AMD, Mathews TJ, McBride OMB, Dunning J. Does blood transfusion increase the chance of recurrence in patients undergoing surgery for lung cancer? Interact Cardiovasc Thorac Surg 2011; 14:85-90. [PMID: 22108935 DOI: 10.1093/icvts/ivr025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether blood transfusion increases the chance of recurrence in patients undergoing surgery for lung cancer. Altogether 468 papers were found using the reported search, of which 21 represented the best evidence to answer the clinical question. The authors, journal date and country of publication, patient group studied, study type, relevant outcomes and results of these papers were tabulated. Nineteen cohort studies (two of which examined the same or similar data sets as two other studies already included), one comment article and one meta-analysis were identified. In total, the outcomes of 5378 patients undergoing surgical resection for lung cancer were analysed. The transfusion rate varied between 15 and 67%. The primary endpoints in all 21 papers were recurrence, survival or disease-free survival. We conclude that the research undertaken to examine the relationship between blood transfusion and lung cancer recurrence, survival and disease-free survival comes to no definite conclusion. Half of the papers relating to recurrence state that there is no significantly increased risk of recurrence with transfusion, whereas the other half state that there is. However, four of the five papers examining disease-free survival demonstrate a significant adverse relationship between this primary outcome and blood transfusion. With regard to survival, five of the papers reviewed showed no effect of blood transfusion, whereas five showed some form of adverse effect. Although there is no overwhelming agreement among the presented evidence, there is a slightly larger body of evidence supporting the theory that blood transfusions are associated with poorer outcomes in patients undergoing resection for lung cancer. However, whether this is a direct effect, or a surrogate marker for other factors such as anaemia, is unclear.
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Intraoperative Factors and the Risk of Respiratory Complications After Pneumonectomy. Ann Thorac Surg 2011; 92:1188-94. [DOI: 10.1016/j.athoracsur.2011.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 06/08/2011] [Accepted: 06/13/2011] [Indexed: 11/20/2022]
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Post-pneumonectomy Pulmonary Edema. Intensive Care Med 2009. [DOI: 10.1007/978-0-387-92278-2_45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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de Perrot M, McRae K, Anraku M, Karkouti K, Waddell TK, Pierre AF, Darling G, Keshavjee S, Johnston MR. Risk Factors for Major Complications After Extrapleural Pneumonectomy for Malignant Pleural Mesothelioma. Ann Thorac Surg 2008; 85:1206-10. [DOI: 10.1016/j.athoracsur.2007.11.065] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 11/23/2007] [Accepted: 11/26/2007] [Indexed: 11/30/2022]
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