Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer

Edna, Tom-Harald; Bjerkeset, T

doi:10.1007/bf02235758

Cited by 88 publications

(55 citation statements)

References 42 publications

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“…This angiogenic factor imbalance was associated with enhanced in vitro angiogenesis. However, Edna and Bjerkeset [6] failed to find any relationship between the time of blood storage and long-term prognosis. On the other hand, Mynster et al [20] showed that buffy-coat-depleted red cells stored for less than 21 day could be an independent risk factor for cancer recurrence, while blood stored more than 21 days had insignificant effect on the risk of recurrence.…”

Section: Discussionmentioning

confidence: 97%

“…Following these early reports, several other studies have been published in the literature with contradictory results. Some of these studies have shown an adverse effect of transfusion on the prognosis of patients with colorectal carcinoma [4][5][6]. Conversely, others have found no transfusion-dependent effect on survival and recurrence [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

et al. 2012

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The aim of our study was to evaluate the prognostic significance of blood transfusion on recurrence and survival in patients undergoing curative resections for colorectal cancer. Retrospective analysis of prospectively collected data of patients after elective resections for colorectal cancer between January 2001 and December 2009 was undertaken. The main endpoint was overall survival, disease-free survival, and recurrence rate. These data were evaluated in relation to blood transfusion (group A, no blood transfusion; group B, one to two blood transfusions; group C, three and more blood transfusions). A total of 583 patients met the criteria for inclusion in the study. Of these, 132 (22.6 %) patients received blood transfusion in the perioperative period. There were 83 (14.2 %) patients who received one or two blood transfusions and 49 (8.4 %) patients who required three or more transfusions. Patients with three or more transfusions had a significantly worse 5-year overall survival, disease-free survival, and increased incidence of distant recurrences in comparison with the group without transfusion or the group with one or two transfusions. Multivariate analysis showed that the application of three or more blood transfusions is an independent risk factor for overall survival (P 00.001; HR 2.158; 95 % CI 1.370-3.398), disease-free survival (P<0.001; HR 2.514; 95 % CI 1.648-3.836), and the incidence of distant recurrence (P<0.001; HR 2.902; 95 % CI 1.616-5.212). Application of three or more blood transfusions in patients operated for colorectal carcinoma is an adverse prognostic factor. Indications for blood transfusion should be carefully considered not only with regard to the risk of early complications, but also because of the possibility of compromising long-term results.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

et al. 2012

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“…[6][7][8] Patients given pre-operative oral iron supplements were discharged from hospital earlier than the non-intervention group (median length of stay 11.5 days [range, 6-35 days] in no-iron group, 10 days [range, 6-26 days] in the iron group; not significant). This may, in part, be secondary to the reduced level of transfusion.…”

Section: Discussionmentioning

confidence: 99%

Pre-Operative Oral Iron Supplementation Reduces Blood Transfusion in Colorectal Surgery – A Prospective, Randomised, Controlled Trial

Lidder

Sanders

Whitehead

et al. 2007

annals

106

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Ann R Coll Surg Engl 2007; 89: 418-421 418Colorectal cancer is the third most common cancer in the UK. 1 Rates of peri-operative transfusion ranging from 20-75% have been reported in patients undergoing colorectal resection. 2,3Despite innovations in transfusion medicine, peri-operative transfusion of allogeneic blood components has inherent risks including immunomodulation, transmission of disease, allergic reaction, and allo-immunisation. More recently, the introduction of leukocyte-depleted blood has led to an increased cost pressure on health resources.Studies have shown that predictors of increased perioperative transfusion are proximal tumours, increasing tumour size, operative blood loss and pre-operative anaemia. 2,4,5Pre-operative anaemia is a frequent finding in this group of surgical patients and accounts for a substantial number of blood transfusions. Defining anaemia as a haemoglobin of less than 13.5 g/dl in men and 11.5 g/dl in women, locally recorded data from the preceding years' 223 surgical colorectal cancer patients demonstrated that 51% of men and 25% of women were anaemic (38% combined) on admission. The overall transfusion rate in the men and women was 28% and 41%, respectively, whereas in the anaemic patients it was 39% and 68%, respectively.The aim of this study was to assess whether pre-operative oral iron therapy would decrease pre-operative anaemia and, thereby, reduce the incidence of peri-operative transfusion. Patients and MethodsThe study received approval from the Plymouth Healthcare Trust Local Research Ethics Committee.Patients diagnosed with colorectal cancer were identified in out-patient clinics. All patients fit for surgery were SURGICAL ONCOLOGYAnn R Coll Surg Engl 2007; 89: 418-

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“…These findings were unexpected because a growing number of publications suggest that outcomes are unfavorable after transfusion of RBCs with prolonged storage age, [25][26][27][28] although there is by no means a consensus regarding the effect of blood storage age on cancer recurrence. 29,30 Gao et al 31 demonstrated the presence of circulating prostate cancer cells in the peripheral blood obtained from patients with prostate cancer immediately before prostatectomy. Therefore, the perioperative period is critical in the cancer disease process because any immunosuppressive intervention may facilitate formation of micrometastases.…”

Section: Discussionmentioning

confidence: 99%

“…17 The clinical evidence of the effect of blood storage age on cancer recurrence is less clear than the evidence in animal models. For example, Edna and Bjerkeset 29 found that blood storage time had no effect on local recurrences and distant metastases in 336 patients who had colorectal resective cancer surgery. However, Mynster and Nielsen 30 demonstrated that, compared with patients who did not undergo transfusion, those who received allogeneic blood stored for less than 21 days had increased locoregional cancer recurrence after colorectal surgery, whereas those who underwent transfusion with blood with a storage age older than 21 days had a recurrence rate similar to that of nontransfused patients.…”

Section: Discussionmentioning

confidence: 99%

Blood Storage Duration and Biochemical Recurrence of Cancer After Radical Prostatectomy

Cata

Klein

Hoeltge

et al. 2011

Mayo Clinic Proceedings

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Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer

Abstract: We found an independent and significant association between perioperative blood transfusion and poor prognosis in colorectal cancer patients. Blood storage time was not a prognostic factor.

Cited by 88 publications

References 42 publications

Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

Impact of Blood Transfusions on Survival and Recurrence in Colorectal Cancer Surgery

Pre-Operative Oral Iron Supplementation Reduces Blood Transfusion in Colorectal Surgery – A Prospective, Randomised, Controlled Trial

Blood Storage Duration and Biochemical Recurrence of Cancer After Radical Prostatectomy

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