The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery

Hsu, Fu-Kai; Chang, Wen-Kuei; Lin, Kuan-Ju; Liu, Chunyu; Fang, Wen-Liang; Chang, Kuang-Yi

doi:10.3390/cancers13215438

Cited by 9 publications

(13 citation statements)

References 34 publications

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“…( Supplementary Figure S2 ). 6 studies ( 9 , 13 , 21 , 32 , 42 , 50 ) might be the main reason for the high heterogeneity. The funnel plot showed obvious asymmetry and publication bias was detected ( Supplementary Figures S1A,B ).…”

Section: Resultsmentioning

confidence: 99%

Effects of perioperative blood transfusion in gastric cancer patients undergoing gastrectomy: A systematic review and meta-analysis

et al. 2023

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BackgroundThe 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.MethodsWe 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).ResultsFifty-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].ConclusionIn 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.

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Section: Resultsmentioning

confidence: 99%

Effects of perioperative blood transfusion in gastric cancer patients undergoing gastrectomy: A systematic review and meta-analysis

et al. 2023

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“…Further, most meta-analyses stress that current studies lack high-quality data[ 26 ]. In the recent retrospective studies that found no impact of RBC transfusions on long-term survival, some of them applied propensity-score matched analysis; however, preoperative hemoglobin and intraoperative blood loss remain as factors that could not be matched between groups[ 11 , 27 ]. Despite the knowledge of the relevance of anemia in the perioperative setting, conflicting data persist around the impact of intraoperative blood loss on OS and DFS of GC patients[ 28 - 30 ].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

Kawakami¹,

Bonomi²,

Pereira³

et al. 2023

World J Gastrointest Surg

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BACKGROUND Gastric cancer (GC) is still a prevalent neoplasm around the world and its main treatment modality is surgical resection. The need for perioperative blood transfusions is frequent, and there is a long-lasting debate regarding its impact on survival. AIM To evaluate the factors related to the risk of receiving red blood cell (RBC) transfusion and its influence on surgical and survival outcomes of patients with GC. METHODS Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated. Clinicopathological and surgical characteristics data were collected. The patients were divided into transfusion and non-transfusion groups for analysis. RESULTS A total of 718 patients were included, and 189 (26.3%) patients received perioperative RBC transfusion (23 intraoperatively, 133 postoperatively, and 33 in both periods). Patients in the RBC transfusions group were older ( P < 0.001), and had more comorbidities ( P = 0.014), American Society of Anesthesiologists classification III/IV ( P < 0.001), and lower preoperative hemoglobin ( P < 0.001) and albumin levels ( P < 0.001). Larger tumors ( P < 0.001) and advanced tumor node metastasis stage ( P < 0.001) were also associated with the RBC transfusion group. The rates of postoperative complications (POC) and 30-d and 90-d mortality were significantly higher in the RBC transfusion group than in the non-transfusion group. Lower hemoglobin and albumin levels, total gastrectomy, open surgery, and the occurrence of POC were factors associated with the RBC transfusion. Survival analysis demonstrated that the RBC transfusions group had worse disease-free survival (DFS) and overall survival (OS) compared with patients who did not receive transfusion ( P < 0.001 for both). In multivariate analysis, RBC transfusion, major POC, pT3/T4 category, pN+, D1 lymphadenectomy, and total gastrectomy were independent risk factors related to worse DFS and OS. CONCLUSION Perioperative RBC transfusion is associated with worse clinical conditions and more advanced tumors. Further, it is an independent factor related to worse survival in the curative intent gastrectomy setting.

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“…The effect of perioperative blood transfusion on tumor prognosis has always been controversial. In a retrospective study, perioperative blood transfusion was associated with OS and DFS in patients with stage I to III gastric cancer who underwent tumor resection, and the amount of transfusion OS and DFS showed a non-linear dose relationship [ 32 ]. Another multicenter regression study found that perioperative blood transfusion among patients undergoing radical rectal cancer surgery was associated with worse OS, not with worse DFS [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The outcome of intravenous and inhalation anesthesia after pancreatic cancer resection: a retrospective study

et al. 2022

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Background Different types of anesthesia may affect cancer patient’s outcomes, we compared the overall survival (OS) and disease-free survival (DFS) of patients with pancreatic cancer under total intravenous and inhalation anesthesia. Methods The authors collected the electronic medical records of patients who had accepted at a pancreatectomy from January 1, 2010 to December 31, 2016. Patients respectively received total intravenous anesthesia (TIVA) or inhalational anesthesia (INHA). Stabilized inverse probability of treatment weighting (SIPTW)was used to minimize differences. Kaplan–Meier survival was established to analyze the influence of sort of anesthesia on disease-free and overall survival. We compare the effects of each sort of anesthesia on cancer recurrence or metastasis and all-cause mortality. Results A total of 463 patients who had undergone pancreatic cancer resection were collected in this study, of which 421 patients were available (TIVA group, n = 114 INHA group, n = 307). After SIPTW there were no significant differences between the two groups in disease-free survival (hazard ratio, 1.01, 95%CI, 0.78 to 1.29, P = 0.959) or overall survival (hazard ratio, 1.11, 95%CI, 0.87 to 1.42, P = 0.405). Conclusions In conclusion, the present study showed no significant difference in overall survival and disease-free survival between total intravenous anesthesia and volatile anesthesia.

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The Associations between Perioperative Blood Transfusion and Long-Term Outcomes after Stomach Cancer Surgery

Cited by 9 publications

References 34 publications

Effects of perioperative blood transfusion in gastric cancer patients undergoing gastrectomy: A systematic review and meta-analysis

Effects of perioperative blood transfusion in gastric cancer patients undergoing gastrectomy: A systematic review and meta-analysis

Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer

The outcome of intravenous and inhalation anesthesia after pancreatic cancer resection: a retrospective study

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