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Prognostic impact of allogenic blood transfusion following surgical treatment of esophageal cancer

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Summary

Background

Esophageal cancer (EC) surgery is associated with relatively high morbidity and mortality rates and poor overall survival (OS). The impact of allogeneic blood transfusion (aBT) on OS is still a matter of debate. We aimed to investigate the impact of aBT on OS in a homogeneous population of patients undergoing surgical treatment for EC in a single center during a 15-year period.

Methods

In total, 409 patients who had undergone surgical resection for EC were studied. The clinicopathological parameters and OS were compared between 170 patients (41.6%) who received perioperative aBT and 239 patients (58.4%) who did not.

Results

Compared with the non-transfused patients, patients who received aBT had lower preoperative hemoglobin levels, more comorbidities, and a more advanced stage of disease as reflected by tumor diameter, nodal metastases, perineural invasion, and the need for multiorgan resection. Transfused patients suffered more frequently from major postoperative complications (26/170 [21.5%] vs. 13/239 [5.7%], p < 0.001) and had a significantly longer hospital stay (17 vs. 15 days, p < 0.001). Multivariate analysis identified tumor grade (p = 0.02), perineural invasion (p = 0.001), N stage (p < 0.001), major postoperative complications (p = 0.01), and comorbidity (p = 0.04) as independent predictors of OS in patients with EC. Perioperative aBT was not found to be an independent predictor of OS in the entire cohort, neither in the stratified subanalysis.

Conclusion

In our study, an advanced stage of disease and comorbidities resulted in the need for blood transfusion and the occurrence of major postoperative complications, which appeared to decrease the OS in patients with EC.

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Abbreviations

aBT:

Allogeneic blood transfusion

AEG:

Adenocarcinoma of the esophagogastric junction

CI:

Confidence interval

DFS:

Disease-free survival

EC:

Esophageal cancer

HR:

Hazard ratio

OS:

Overall survival

PRBC:

Packed red blood cells

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Authors and Affiliations

  1. Clinic for Digestive Surgery-First Surgical Clinic, Center for Esophageal Surgery, Clinical Center of Serbia, Koste Todorovica St 6, Belgrade, Serbia

    Dejan Velickovic MD,  Predrag Sabljak MD, PhD,  Dejan Stojakov MD, PhD,  Jelena Velickovic MD,  Keramatollah Ebrahimi MD, PhD,  Vladimir Sljukic MD &  Predrag Pesko MD, PhD, FACS

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  1. Dejan Velickovic MD
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  2. Predrag Sabljak MD, PhD
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  3. Dejan Stojakov MD, PhD
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Correspondence to Dejan Velickovic MD.

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D. Velickovic, P. Sabljak, D. Stojakov, J. Velickovic, K. Ebrahimi, V. Sljukic, and P. Pesko declare that they have no competing interests.

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Velickovic, D., Sabljak, P., Stojakov, D. et al. Prognostic impact of allogenic blood transfusion following surgical treatment of esophageal cancer. Eur Surg 51, 246–253 (2019). https://doi.org/10.1007/s10353-019-0588-7

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  • DOI: https://doi.org/10.1007/s10353-019-0588-7

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