Advertisement

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

  • Dejan VelickovicEmail author
  • Predrag Sabljak
  • Dejan Stojakov
  • Jelena Velickovic
  • Keramatollah Ebrahimi
  • Vladimir Sljukic
  • Predrag Pesko
original article
  • 2 Downloads

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.

Keywords

Outcome Esophagectomy Overall survival Squamous cell carcinoma Adenocarcinoma 

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

Notes

Conflict of interest

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

References

  1. 1.
    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–544.CrossRefGoogle Scholar
  2. 2.
    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–602.CrossRefGoogle Scholar
  3. 3.
    Cook MB, Chow WH, Devesa SS. Oesophageal cancer incidence in the United States by race, sex, and histologic type, 1977–2005. Br J Cancer. 2009;101:855–9.CrossRefGoogle Scholar
  4. 4.
    Lepage C, Rachet B, Jooste V, et al. Continuing rapid increase in esophageal adenocarcinoma in England and Wales. Am J Gastroenterol. 2008;103:2694–9.CrossRefGoogle Scholar
  5. 5.
    Bosetti C, Levi F, Ferlay J, et al. Trends in oesophageal cancer incidence and mortality in Europe. Int J Cancer. 2008;122:1118–29.CrossRefGoogle Scholar
  6. 6.
    Reeh M, Ghadban T, Dedow J, et al. Allogenic blood transfusion is associated with poor perioperative and long-term outcome in esophageal cancer. World J Surg. 2017;41:208–15.CrossRefGoogle Scholar
  7. 7.
    Wouters MW, Krijnen P, Le Cessie S, et al. Volume or outcome-based referral to improve quality of care for esophageal cancer surgery in The Netherlands. J Surg Oncol. 2009;99:481–7.CrossRefGoogle Scholar
  8. 8.
    Pennathur A, Luketich JD. Resection for esophageal cancer: strategies for optimal management. Ann Thorac Surg. 2008;85:S751–S6.CrossRefGoogle Scholar
  9. 9.
    Boshier PR, Ziff C, Adam ME, et al. Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis. Dis Esophagus. 2018;31:1–10.Google Scholar
  10. 10.
    Lee J, Chin JH, Kim JI, et al. Association between red blood cell transfusion and long-term mortality in patients with cancer of the esophagus after esophagectomy. Dis Esophagus. 2017;31:1–8.Google Scholar
  11. 11.
    Nozoe T, Miyazaki M, Saeki H, et al. Significance of allogenic blood transfusion on decreased survival in patients with esophageal carcinoma. Cancer. 2001;92:1913–8.CrossRefGoogle Scholar
  12. 12.
    Komatsu Y, Orita H, Sakurada M, et al. Intraoperative blood transfusion contributes to the decreased long-term survival of patients with esophageal cancer. World J Surg. 2012;36:844–50.CrossRefGoogle Scholar
  13. 13.
    Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007;21:327–48.CrossRefGoogle Scholar
  14. 14.
    Cata JP, Wang H, Gottumukkala V, et al. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013;110:690–701.CrossRefGoogle Scholar
  15. 15.
    Blajchman MA. Immunomodulation and blood transfusion. Am J Ther. 2002;9:389–95.CrossRefGoogle Scholar
  16. 16.
    Liu J, Chen S, Chen Y, et al. Perioperative blood transfusion has no effect on overall survival after esophageal resection for esophageal squamous cell carcinoma: a retrospective cohort study. Int J Surg. 2018;55:24–30.CrossRefGoogle Scholar
  17. 17.
    Fjederholt KT, Svendsen LB, Mortensen FV. Perioperative blood transfusions increases the risk of anastomotic leakage after surgery for GEJ-cancer. Am J Surg. 2017;214:293–8.CrossRefGoogle Scholar
  18. 18.
    Meiser A, Casagranda O, Skipka G, et al. Quantification of blood loss. How precise is visual estimation and what does its accuracy depend on? Anaesthesist. 2001;50:13–20.CrossRefGoogle Scholar
  19. 19.
    Ng T, Ryder BA, Chern H, et al. Leukocyte-depleted blood transfusion is associated with decreased survival in resected early-stage lung cancer. J Thorac Cardiovasc Surg. 2012;143:815–9.CrossRefGoogle Scholar
  20. 20.
    Squires MH 3rd, Kooby DA, Poultsides GA, et al. Effect of perioperative transfusion on recurrence and survival after gastric cancer resection: a 7‑institution analysis of 765 patients from the US gastric cancer collaborative. J Am Coll Surg. 2015;221:767–77.CrossRefGoogle Scholar
  21. 21.
    Mavros MN, Xu L, Maqsood H, et al. Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Ann Surg Oncol. 2015;22:4382–91.CrossRefGoogle Scholar
  22. 22.
    Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta analysis. Ann Surg. 2012;256:235–44.CrossRefGoogle Scholar
  23. 23.
    Sugita S, Sasaki A, Iwaki K, et al. Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: a retrospective study. Eur J Surg Oncol. 2008;34:339–45.CrossRefGoogle Scholar
  24. 24.
    Opelz G, Terasaki PI. Improvement of kidney-graft survival with increased numbers of blood transfusions. N Engl J Med. 1978;299:799–803.CrossRefGoogle Scholar
  25. 25.
    Lenhard V, Massen G, Seifert P, et al. Characterization of transfusion-induced suppressor cells in prospective kidney allograft recipients. Transplant Proc. 1982;14:329–32.PubMedGoogle Scholar
  26. 26.
    Kaplan J, Sarnaik S, Gitlin J, et al. Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood. 1984;64:308–10.PubMedGoogle Scholar
  27. 27.
    Wood ML, Gottschalk R, Monaco AP. Effect of blood transfusion on IL-2 production. Transplantation. 1988;45:930–5.CrossRefGoogle Scholar
  28. 28.
    Marquet RL, Hoynck van Papendrecht MA, Busch OR, et al. Blood donation leads to a decrease in natural killer cell activity: a study in normal blood donors and cancer patients. Transfusion. 1992;33:368–73.CrossRefGoogle Scholar
  29. 29.
    Fields RC, Meyers BF. The effects of perioperative blood transfusion on morbidity and mortality after esophagectomy. Thorac Surg Clin. 2006;16:75–86.CrossRefGoogle Scholar
  30. 30.
    Swisher SG, Holmes EC, Hunt KK, et al. Perioperative blood transfusions and decreased long-term survival in esophageal cancer. J Thorac Cardiovasc Surg. 1996;112:341–8.CrossRefGoogle Scholar
  31. 31.
    Tachibana M, Tabara H, Kotoh T, et al. Prognostic significance of perioperative blood transfusions in resectable thoracic esophageal cancer. Am J Gastroenterol. 1999;94:757–65.CrossRefGoogle Scholar
  32. 32.
    Craig SR, Adam DJ, Yap PL, et al. Effect of blood transfusion on survival after esophagogastrectomy for carcinoma. Ann Thorac Surg. 1998;66:356–61.CrossRefGoogle Scholar
  33. 33.
    Dresner SM, Lamb PJ, Shenfine J, et al. Prognostic significance of peri-operative blood transfusion following radical resection for oesophageal carcinoma. Eur J Surg Oncol. 2000;26:492–7.CrossRefGoogle Scholar
  34. 34.
    Langley SM, Alexiou C, Bailey DH, et al. The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma. Ann Thorac Surg. 2002;73:1704–9.CrossRefGoogle Scholar
  35. 35.
    Nafteux P, Depypere L, Van Veer H, et al. Principles of esophageal cancer surgery, including surgical approaches and optimal node dissection (2- vs. 3‑field). Ann Cardiothorac Surg. 2017;6:152–8.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Clinic for Digestive Surgery-First Surgical Clinic, Center for Esophageal SurgeryClinical Center of SerbiaBelgradeSerbia

Personalised recommendations