Journal of Gastrointestinal Surgery

, Volume 18, Issue 9, pp 1575–1587

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

  • Jeffrey M. Sutton
  • David A. Kooby
  • Gregory C. Wilson
  • M. Hart SquiresIII
  • Dennis J. Hanseman
  • Shishir K. Maithel
  • David J. Bentrem
  • Sharon M. Weber
  • Clifford S. Cho
  • Emily R. Winslow
  • Charles R. Scoggins
  • Robert C. G. MartinII
  • Hong Jin Kim
  • Justin J. Baker
  • Nipun B. Merchant
  • Alexander A. Parikh
  • Daniel E. Abbott
  • Michael J. Edwards
  • Syed A. Ahmad
SSAT Quick Shot Presentation

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.

Keywords

Pancreatic adenocarcinoma Pancreaticoduodenectomy Whipple Blood transfusion Survival 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2014

Authors and Affiliations

  • Jeffrey M. Sutton
    • 1
  • David A. Kooby
    • 2
  • Gregory C. Wilson
    • 1
  • M. Hart SquiresIII
    • 2
  • Dennis J. Hanseman
    • 1
  • Shishir K. Maithel
    • 2
  • David J. Bentrem
    • 3
  • Sharon M. Weber
    • 4
  • Clifford S. Cho
    • 4
  • Emily R. Winslow
    • 4
  • Charles R. Scoggins
    • 5
  • Robert C. G. MartinII
    • 5
  • Hong Jin Kim
    • 6
  • Justin J. Baker
    • 6
  • Nipun B. Merchant
    • 7
  • Alexander A. Parikh
    • 7
  • Daniel E. Abbott
    • 1
  • Michael J. Edwards
    • 1
  • Syed A. Ahmad
    • 1
  1. 1.Division of Surgical Oncology, Department of SurgeryUniversity of Cincinnati College of MedicineCincinnatiUSA
  2. 2.Department of SurgeryEmory University School of MedicineAtlantaUSA
  3. 3.Department of SurgeryNorthwestern University Feinberg School of Medicine and Jesse Brown VA Medical CenterChicagoUSA
  4. 4.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  5. 5.Department of SurgeryUniversity of Louisville School of MedicineLouisvilleUSA
  6. 6.Department of SurgeryUniversity of North Carolina School of MedicineChapel HillUSA
  7. 7.Department of SurgeryVanderbilt University School of MedicineNashvilleUSA

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