Impact of Intraoperative Blood Loss on the Survival of Patients With Stage II/III Colorectal Cancer: A Multicenter Retrospective Study

Abstract

Background: Resection of the primary lesion with radical lymph node dissection is the most promising treatment avenue for patients with cancer. On the other hand, these procedures often induce excessive intraoperative blood loss (IBL) and require perioperative blood transfusion. The influence of IBL on the long-term postoperative outcomes of patients with digestive cancer is controversial. We investigated the impact of IBL on survival and recurrence after curative surgery in patients with colorectal cancer (CRC) in a single study group. Patients and Methods: In total, 1,597 patients who underwent radical resection for CRC at three group hospitals between 2000 and 2019 were reviewed. Patients were classified into a group with high IBL (≥200 ml) or low IBL (<200 ml). The risk factors for disease-free (DFS) and overall (OS) survival were analyzed. Results: A total of 489 and 1,108 patients were classified into the high and low IBL groups, respectively. The OS and DFS rates at 5 years after surgery were 89.3% and 63.4%, respectively, for the high IBL group and 96.9% and 77.8% for the low IBL group; these differences were statistically significantly (p<0.001). The multivariate analysis demonstrated that IBL was a significant independent risk factor for OS and DFS. Conclusion: The amount of IBL was associated with significant differences in the OS and DFS of patients with stage II/III CRC who received curative resection. The surgical procedure, surgical strategy, and perioperative care should be carefully planned to avoid causing IBL.Colorectal cancer (CRC) remains the fourth cancer-specific cause of death worldwide and the second and third leading cause in males and females, with an estimated 1.09 million new cases and 551,200 deaths occurring in 2018 (1). Complete resection is essential to obtain a cure in cases of CRC. 5-Year relative survival of patients diagnosed with CRC was 90.1% for patients with localized stage, 69.2% for patients with regional spread, and 11.7% for patients with distant tumor spread. In particular, patients with stage II/III CRC often develop recurrence, even after complete curative resection. It is reported that approximately 21-42% of patients with stage II/III CRC develop recurrent disease, such as local recurrence or distant metastasis (2). Recently, adjuvant treatment was introduced for stage II/III CRC and has improved patient survival (3,4). Consequently, it is important to determine prognostic factors for stage II/III CRC, as it would facilitate the selection of patients who can benefit from more aggressive treatment. In patients with CRC, Burrow and Tartter (5) were the first to report the risk associated with perioperative blood transfusion in 1982. Since then, some reports have documented the relationship between intraoperative blood loss (IBL) and a poor prognosis of patients with some types of cancer (6)(7)(8)(9)(10)(11) 3483 This article is freely accessible online.

Effect of intraoperative blood loss on postoperative complications and prognosis of patients with colorectal cancer: A meta‑analysis

“…After browsing the titles and abstracts, 42 studies were left for full-text scanning. Finally, 7 studies (7,12,(17)(18)(19)(20)(21) were included in this study (Fig. 1).…”

“…A total of seven studies (7,12,(17)(18)(19)(20)(21) reported on OS and two studies (7,19) reported on DFS of patients with CRC who underwent radical CRC surgery. The random-effects model was used to calculate the HR values.…”

“…The treatment of CRC includes surgery, chemotherapy, radiotherapy and immunotherapy (3)(4)(5). Surgery is still the main treatment for CRC and radical resection is the key to cure (6,7).…”

“…However, the predictive effect of IBL on complications and prognosis has been controversial. Tamagawa et al ( 7 ) reported that the reduction of IBL may improve the overall survival (OS) and disease-free survival (DFS) of patients with CRC. However, Egenvall et al ( 12 ) indicated that major IBL increases the risk of postoperative complications, but may not affect OS.…”

Short-term and long-term outcomes of natural orifice specimen extraction surgeries (NOSES) in rectal cancer: a comparison study of NOSES and non-NOSES

“…Data also correlated blood loss with short-term and long-term outcomes of CRC. The amount of intraoperative blood loss was associated with significant differences in the OS and DFS of patients with stage II/III CRC who received curative resection (13). Another study also found that the degree of blood loss during surgery for colon cancer was a factor that influences long-term survival (14).…”