Intraoperative blood loss does not independently affect the survival outcome of gastric cancer patients who underwent curative resection

Zhao, Baisong; Huang, Xinyu; Lu, Haoxian; Zhang, J.; Luo, Rui; Xu, Hui; Huang, Baojun

doi:10.1007/s12094-019-02046-6

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…This is the first study to report a negative impact of IBL on the long-term outcome of patients with gastric cancer using data from a large-scale, multicenter, prospective cohort. The median IBL for all 1203 patients was 285 ml, which was similar to what was reported by previous studies [10,12,13,15]. Increased IBL was associated with male sex, higher BMI, larger tumor size, total gastrectomy, and cases where combined organ resection was required, correlations also similar to previous reports.…”

Section: Discussionsupporting

confidence: 90%

“…Their retrospective analysis of 152 patients with transmural advanced gastric cancer found that IBL > 500 ml was an independent prognostic factor of long-term survival. Several subsequent works also identified excessive IBL as predictive of a worse prognosis with different cutoff values assigned by each [9][10][11][12][13], while others did not associate IBL with outcome [14][15][16]. The issue of IBL and prognosis, while well studied, is unsettled.…”

Section: Introductionmentioning

confidence: 99%

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Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial

et al. 2021

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Background Recent retrospective studies have shown that increased intraoperative blood loss (IBL) during curative gastrectomy for patients with advanced gastric cancer is a negative prognostic indicator for recurrence. However, there are no reliable reports assessing this with a large-scale prospective cohort. This study aimed to evaluate the impact of IBL on long-term outcomes using data from the JCOG1001 phase III trial, which was designed to determine if bursectomy led to improved survival vs. nonbursectomy in patients with cT3/4a gastric cancer. Methods This study included 1203 of the 1204 patients enrolled in the JCOG1001. From the tertiles of IBL (196 ml, 400 ml), we divided the patients into three groups: IBL < 200 ml representing small blood loss (SBL, n = 404), 200 ml ≤ IBL < 400 ml representing medium blood loss (MBL, n = 393), and IBL ≥ 400 ml representing large blood loss (LBL, n = 406). The impact of IBL on relapse-free survival (RFS) was evaluated with univariable comparisons and multivariable Cox regression analyses. Results Three-year RFS after SBL, MBL, and LBL was 81.7%, 74.8%, and 70.6%, respectively. Multivariable analysis identified IBL, Eastern Cooperative Oncology Group performance status, pT, pN, and postoperative adjuvant chemotherapy as independent predictors of RFS. Compared with SBL as a reference, the hazard ratios of MBL and LBL were 1.461 (P = 0.012) and 1.520 (P = 0.009), respectively. Conclusions Based on the analysis of data from a large-scale prospective study, an IBL of ≥ 200 ml after curative surgery for patients with cT3/4a gastric cancer was an independent predictor of reduced RFS.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial

et al. 2021

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“…Ito et al also reported that IBL adversely influenced the long-term outcomes of patients with stage II/III gastric cancer (9). On the other hand, it was also reported that the minimization of IBL was very important but not an independent prognostic factor for patients with cancer (18,19). There have been very few articles about the association between IBL and the long-term outcomes of CRC.…”

Section: Discussionmentioning

confidence: 99%

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

Numata

Aoyama

Kazama

et al. 2021

In Vivo

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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.

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“…In pancreatic cancer, Nagai et al reported that IBL was a prognostic determinant of survival after surgery for pancreatic cancer and that operative blood loss enabled stratification of patients by risk of pancreatic cancer mortality (18). On the other hand, there are also studies that whilst emphasizing the importance of minimizing IBL did not find it to be an independent prognostic factor in patients with cancer (21,22). In our study, survival was independently influenced by IBL in patients who underwent curative surgery for pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Intraoperative Blood Loss on the Survival of Patients With Stage II/III Pancreatic Cancer

Aoyama

Yamamoto

Kamiya

et al. 2020

In Vivo

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Background: Pancreatic cancer is a fatal disease with a poor prognosis. Pancreatic cancer is often unresectable at the time of diagnosis, so the analysis of risk factors in patients with indications for surgery is important. We investigated the impact of intraoperative blood loss (IBL) on survival and recurrence in patients with stage II/III pancreatic cancer after curative surgery. Patients and Methods: This study included 76 patients who underwent curative surgery for stage II/III pancreatic cancer between 2007 and 2012. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. Results: IBL of 1,000 ml was considered to be the optimal cutoff value for classification based on a receiver operating characteristic (ROC) curve analysis. The OS rates at 5 years after surgery in the groups with low and high IBL were 36.6% and 11.4%, respectively, which was a statistically significant difference (p=0.003). The RFS rates at 1 year after surgery were 49.8% and 24.6%, respectively, which was a significant difference (p=0.045). A multivariate analysis demonstrated that IBL was a significant independent risk factor for OS. Conclusion: IBL is an independent prognostic factor after curative resection of stage II/III pancreatic cancer. The reduction of bleeding during surgery is necessary to improve the results of pancreatic cancer surgery.

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Intraoperative blood loss does not independently affect the survival outcome of gastric cancer patients who underwent curative resection

Cited by 17 publications

References 27 publications

Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial

Negative impact of intraoperative blood loss on long-term outcome after curative gastrectomy for advanced gastric cancer: exploratory analysis of the JCOG1001 phase III trial

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

The Impact of Intraoperative Blood Loss on the Survival of Patients With Stage II/III Pancreatic Cancer

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