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Perioperative Blood Transfusion Is Associated with Decreased Survival in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: a Multi-institutional Study

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

In this multi-institutional study of patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, we sought to identify factors associated with perioperative transfusion requirement as well as the association between blood transfusion and perioperative and oncologic outcomes.

Methods

The surgical databases across six high-volume institutions were analyzed to identify patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma from 2005 to 2010. For statistical analyses, patients were then stratified by transfusion volume according to whether they received 0, 1–2, or >2 units of packed red blood cells.

Results

Among 697 patients identified, 42 % required blood transfusion. Twenty-three percent received 1–2 units, and 19 % received >2 units. Factors associated with an increased transfusion requirement included older age, heart disease, diabetes, longer operative time, higher blood loss, tumor size, and non-R0 margin status (all p < 0.05). The median disease-free survival (13.8 vs. 18.3 months, p = 0.02) and overall survival (14.0 vs. 21.0 months, p < 0.0001) durations of transfused patients were shorter than those of transfusion-free patients. Multivariate modeling identified intraoperative transfusion of >2 units (hazard ratio, 1.92, p = 0.009) and postoperative transfusions as independent factors associated with decreased disease-free survival.

Conclusions

This multi-institutional study represents the largest series to date analyzing the effects of perioperative blood transfusion on patient outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma. While blood transfusion was not associated with increased rate of infectious complications, allogeneic blood transfusion did confer a negative impact on disease-free and overall survival.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219, USA

    Jeffrey M. Sutton, Gregory C. Wilson, Dennis J. Hanseman, Daniel E. Abbott, Michael J. Edwards & Syed A. Ahmad

  2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    David A. Kooby, M. Hart Squires III & Shishir K. Maithel

  3. Department of Surgery, Northwestern University Feinberg School of Medicine and Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem

  4. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber, Clifford S. Cho & Emily R. Winslow

  5. Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA

    Charles R. Scoggins & Robert C. G. Martin II

  6. Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Hong Jin Kim & Justin J. Baker

  7. Department of Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA

    Nipun B. Merchant & Alexander A. Parikh

Authors
  1. Jeffrey M. Sutton
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  2. David A. Kooby
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  3. Gregory C. Wilson
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  6. Shishir K. Maithel
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  7. David J. Bentrem
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  8. Sharon M. Weber
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  9. Clifford S. Cho
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  10. Emily R. Winslow
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  11. Charles R. Scoggins
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  12. Robert C. G. Martin II
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  13. Hong Jin Kim
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  14. Justin J. Baker
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  15. Nipun B. Merchant
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  16. Alexander A. Parikh
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  17. Daniel E. Abbott
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  18. Michael J. Edwards
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  19. Syed A. Ahmad
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Correspondence to Syed A. Ahmad.

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Sutton, J.M., Kooby, D.A., Wilson, G.C. et al. Perioperative Blood Transfusion Is Associated with Decreased Survival in Patients Undergoing Pancreaticoduodenectomy for Pancreatic Adenocarcinoma: a Multi-institutional Study. J Gastrointest Surg 18, 1575–1587 (2014). https://doi.org/10.1007/s11605-014-2567-4

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  • DOI: https://doi.org/10.1007/s11605-014-2567-4

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