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

Aoyama, Toru; Yamamoto, Naoto; Kamiya, Mako; Murakawa, Masaaki; Atsumi, Yoshihito; Numata, Masakatsu; Kazama, Keisuke; Hara, Kentaro; Yukawa, Norio; Rino, Yasushi; Masuda, Munetaka; Morinaga, Soichiro

doi:10.21873/invivo.11931

Cited by 14 publications

(16 citation statements)

References 25 publications

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“…In hepatocellular carcinoma, Katz et al reported increased IBL during hepatic resection to be an independent prognostic factor for tumor recurrence and death (10). In pancreatic cancer, Tamagawa et al showed that IBL ≥1,000 ml was an independent risk factor for poor OS and DFS, as well as postoperative morbidity, in patients with stage II/III pancreatic cancer who underwent radical surgery (17). Nagai et al also reported that IBL was a prognostic determinant of survival after surgery for pancreatic cancer and that operative blood loss can be used to stratify the risk of pancreatic cancer mortality (7).…”

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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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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“…Hiroshi et al also reported that increased intraoperative blood loss in patients undergoing curative resection of stage II/III pancreatic cancer was an independent risk factor for overall and recurrence-free survival in a retrospective study. 26 Operative blood loss in curative surgeries for other digestive carcinomas including hepatocellular carcinoma, gastric cancer and colorectal cancer has also been correlated with cancer recurrence. [27][28][29][30][31] Increased operative blood loss is closely related to allogeneic blood transfusion, which may cause tumor cell spreading due to downregulation of the immune response.…”

Section: Discussionmentioning

confidence: 99%

Effect of epidural analgesia on long-term outcomes after curative surgery for pancreatic cancer: A single-center cohort study in Taiwan

Lin

Hsu

Shyr

et al. 2021

Journal of the Chinese Medical Association

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Background: Whether epidural anesthesia and analgesia (EA) improves long-term outcomes after pancreatic cancer surgery remains controversial. We conducted this retrospective cohort study to investigate the influence of EA on cancer recurrence and overall survival after surgery for pancreatic cancer. Methods: We conducted an electronic medical chart review of patients with pancreatic cancer who underwent curative resection at our hospital from 2008 to 2017 and were followed up until December 2019. Patient demographics, anesthetic and surgical characteristics, and pathologic features were also collected. The effects of EA on postoperative cancer recurrence and overall survival were evaluated using proportional hazards regression models with inverse probability of treatment weighting (IPTW) based on propensity scores to balance unequal distributions of observed covariates. For sensitivity analysis, multivariable regression modeling and quintile-stratified propensity adjustments were also used. Results: Among the 252 included patients, the median follow-up period was 15.9 months (interquartile range 6.8-28.2 months), and 88 (35%) received EA after pancreatic cancer surgery. EA was not associated with greater cancer recurrence (IPTW adjusted HR: 0.98; 95% CI, 0.78%-1.24%; p = 0.87) or all-cause mortality (IPTW adjusted HR: 1.02; 95% CI, 0.82%-1.27%; p = 0.85) after pancreatic cancer resection. In sensitivity analysis, both the multivariable and stratified Cox regression analyses failed to demonstrate significant effects of EA on cancer recurrence and survival after surgery. Conclusion: There were no significant associations between EA and cancer recurrence and overall survival after curative surgery for pancreatic cancer. Prospective studies should be considered to elucidate the relationship between EA and cancer outcomes after pancreatic cancer surgery.

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“…Combined organ resection is often associated with extensive lymphadenectomy, more surgical incisions, more blood loss, and prolonged operation time, which may impair patients’ immunity and increase the risk of postoperative complications. It has been reported that the overall survival rate of patients undergoing radical gastrectomy for gastric cancer is influenced by the volume of intraoperative blood loss [33–35] . Therefore, indications for combined organ resection need to be evaluated carefully, and potential new surgical methods to reduce the incidence of anastomotic leakage after combined organ resection should be explored.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that the overall survival rate of patients undergoing radical gastrectomy for gastric cancer is influenced by the volume of intraoperative blood loss. [33][34][35] Therefore, indications for combined organ resection need to be evaluated carefully, and potential new surgical methods to reduce the incidence of anastomotic leakage after combined organ resection should be explored.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for anastomotic leakage after gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a retrospective case-control study

Shi

You

et al. 2021

J Bio-X Res

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Objective: To identify risk factors for anastomotic leakage after gastrectomy in patients with Siewert type II/III adenocarcinoma (AEG) of the esophagogastric junction. Methods: This was a retrospective case-control study of 903 patients with Siewert type II/III AEG treated from January 2012 to January 2015 at the Shanxi Cancer Hospital in China. All patients underwent gastrectomy, and their clinical characteristics were analyzed to identify associations with anastomotic leakage. Independent risk factors were identified by binary logistic regression. The 2-year disease-free survival was calculated and compared between patients with anastomotic leakage and control patients. The study was approved by the Institutional Review Board of Shanxi Medical University (approval No. 2014-09-39) on September 19, 2014. Results: Out of the 903 patients were included in the study, 80 (8.86%, 80/903) experienced anastomotic leakage. The mortality rate attributed to anastomotic leakage was 8.75% (7/80). Logistic regression analysis revealed that preoperative hypoalbuminemia (odds ratio (OR) = 3.249, 95% confidence interval (CI): 1.569–6.725, P = 0.002), type of reconstruction (OR = 1.795, 95% CI: 1.026–3.142, P = 0.040), and combined organ resection (OR = 1.807, 95% CI: 1.069–3.055, P = 0.027) were independent risk factors for anastomotic leakage. Conclusion: Preoperative hypoalbuminemia, type of reconstruction, and combined organ resection were identified as risk factors for anastomotic leakage in patients undergoing gastrectomy for Siewert type II/III AEG.

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

Cited by 14 publications

References 25 publications

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

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

Effect of epidural analgesia on long-term outcomes after curative surgery for pancreatic cancer: A single-center cohort study in Taiwan

Risk factors for anastomotic leakage after gastrectomy for Siewert type II/III adenocarcinoma of the esophagogastric junction: a retrospective case-control study

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