Skip to main content

Advertisement

SpringerLink
Log in

Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript

Abstract

Background

Perioperative blood transfusion has been associated with a poor prognosis in patients undergoing surgery for colorectal cancer. The aim of this study was to evaluate risk factors for blood transfusion and its impact on long-term outcome exclusively in patients undergoing laparoscopic surgery for curable colorectal cancer.

Methods

Data were retrieved from a prospectively collected database of patients who underwent laparoscopic surgery for curable colorectal cancer over a 6-year period. Long-term data were collected from our outpatient clinic and personal contact when necessary.

Results

Two hundred and one patients underwent laparoscopic surgery for curable colorectal cancer (stage I–III). Sixty-eight (33.8 %) received blood transfusions during or after surgery. These patients were typically older, had lower preoperative hemoglobin levels, had a more advanced cancer, had a higher Charlson score, had a higher rate of complications and had a higher conversion rate. Kaplan–Meier overall survival analysis was significantly worse in patients who received blood transfusions (P = 0.004). Decreased disease-free survival was also observed in transfused patients; however, this did not reach statistical significance (P = 0.21). A multivariate analysis revealed that transfusion was not an independent risk factor for decreased overall and disease-free survival. The Charlson score was the only independent risk factor for overall survival (OR = 2.1, P = 0.002). Independent factors affecting disease-free survival were stage of disease, Charlson score and, to a lesser degree, age and body mass index.

Conclusions

Perioperative blood transfusion is associated with decreased long-term survival in patients undergoing laparoscopic resection for colorectal cancer. However, this association apparently reflects the poorer medical condition of patients requiring surgery and not a causative relationship.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Burrows L, Tartter P (1982) Effects of blood transfusions on colonic malignancy recurrence rate. Lancet 2:662

    Article  PubMed  CAS  Google Scholar 

  2. Blumberg N, Agarwal MM, Chuang C (1985) Relation between recurrence of cancer of the colon and blood transfusion. BMJ 290:1037–1039

    Article  PubMed  CAS  Google Scholar 

  3. Edna TH, Bjerkeset T (1998) Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer. Dis Colon Rectum 41:451–459

    Article  PubMed  CAS  Google Scholar 

  4. Miki C, Hiro J, Ojima E, Inoue Y, Mohri Y, Kusunoki M (2006) Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer. Clin Oncol (R Coll Radiol) 18:60–66

    Article  CAS  Google Scholar 

  5. Sabalić S, Kovacević D, Glavić Z et al (2006) The immunomodulation effect of allogenic blood transfusion in colorectal cancer—a new approach. Coll Antropol 30:885–893

    PubMed  Google Scholar 

  6. Baumgartner JM, Nydam TL, Clarke JH, Banerjee A, Silliman CC, McCarter MD (2009) Red blood cell supernatant potentiates LPS-induced proinflammatory cytokine response from peripheral blood mononuclear cells. J Interferon Cytokine Res 29:333–338

    Article  PubMed  CAS  Google Scholar 

  7. Braga M, Pecorelli N, Frasson M, Vignali A, Zuliani W, Carlo VD (2011) Long-term outcomes after laparoscopic colectomy. World J Gastrointest Oncol 3:43–48

    Article  PubMed  Google Scholar 

  8. Braga M, Vignali A, Zuliani W et al (2002) Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial. Dis Colon Rectum 45:1070–1077

    Article  PubMed  Google Scholar 

  9. Braga M, Vignali A, Gianotti L et al (2002) Laparoscopic versus open colorectal surgery: a randomized trial on short-term outcome. Ann Surg 236:759–766

    Article  PubMed  Google Scholar 

  10. Leung KL, Tsang KS, Ng MH et al (2003) Lymphocyte subsets and natural killer cell cytotoxicity after laparoscopically assisted resection of rectosigmoid carcinoma. Surg Endosc 17:1305–1310

    Article  PubMed  CAS  Google Scholar 

  11. Amato AC, Pescatori M (1998) Effect of perioperative blood transfusions on recurrence of colorectal cancer: metaanalysis stratified on risk factors. Dis Colon Rectum 41:570–585

    Article  PubMed  CAS  Google Scholar 

  12. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  Google Scholar 

  14. Frank SM, Savage WJ, Rothschild JA et al (2012) Variability in blood and blood component utilization as assessed by anaesthesia information management system. Anesthesiology 117:99–106

    Article  PubMed  Google Scholar 

  15. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev 25:CD005033

    Google Scholar 

  16. Vignali A, Braga M, Zuliani W et al (2004) Laparoscopic colorectal surgery modifies risk factors for postoperative morbidity. Dis Colon Rectum 47:1686–1693

    Article  PubMed  Google Scholar 

  17. Kiran RP, Delaney CP, Senagore AJ, Millward BL, Fazio VW (2004) Operative blood loss and use of blood products after laparoscopic and conventional open colorectal operations. Arch Surg 139:39–42

    Article  PubMed  Google Scholar 

  18. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57

    Article  PubMed  Google Scholar 

  19. Law WL, Poon JT, Fan JK, Lo OS (2012) Survival following laparoscopic versus open resection for colorectal cancer. Int J Colorectal Dis 27:1077–1085

    Article  PubMed  Google Scholar 

  20. Busch OR, Hop WC, Hoynck van Papendrecht MA, Marquet RL, Jeekel J (1993) Blood transfusions and prognosis in colorectal cancer. N Engl J Med 328:1372–1376

    Article  PubMed  CAS  Google Scholar 

  21. Busch OR, Hop WC, Marquet RL, Jeekel J (1994) Blood transfusions and local tumor recurrence in colorectal cancer. Evidence of a noncausal relationship. Ann Surg 220:791–797

    Article  PubMed  CAS  Google Scholar 

  22. Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial. Ann Surg 246:655–662

    Article  PubMed  Google Scholar 

  23. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC trial group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  24. Lacy AM, Delgado S, Castells A et al (2008) The long-term results of a randomized clinical trial of laparoscopy-assisted versus open surgery for colon cancer. Ann Surg 248:1–7

    Article  PubMed  Google Scholar 

  25. Chan AC, Poon JT, Fan JK, Lo SH, Law WL (2008) Impact of conversion on the long-term outcome in laparoscopic resection of colorectal cancer. Surg Endosc 22:2625–2630

    Article  PubMed  Google Scholar 

  26. White I, Greenberg R, Itah R, Inbar R, Schneebaum S, Avital S (2011) Impact of conversion on short and long-term outcome in laparoscopic resection of curable colorectal cancer. JSLS 15:182–187

    Article  PubMed  Google Scholar 

  27. Donohue JH, Williams S, Cha S et al (1995) Perioperative blood transfusions do not affect disease recurrence of patients undergoing curative resection of colorectal carcinoma: a Mayo/North Central Cancer Treatment Group study. J Clin Oncol 13:1671–1678

    PubMed  CAS  Google Scholar 

  28. Jagoditsch M, Pozgainer P, Klingler A, Tschmelitsch J (2006) Impact of blood transfusions on recurrence and survival after rectal cancer surgery. Dis Colon Rectum 49:1116–1130

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery B, Meir Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Kfar-Saba, Israel

    R. Ghinea, I. White & S. Avital

  2. Department of Surgery, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    R. Greenberg & H. Mahagna

  3. Department of Oncology, Tel Aviv Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    E. Sacham-Shmueli

Authors
  1. R. Ghinea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Greenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. White
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Sacham-Shmueli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H. Mahagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. S. Avital
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Avital.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ghinea, R., Greenberg, R., White, I. et al. Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival. Tech Coloproctol 17, 549–554 (2013). https://doi.org/10.1007/s10151-013-1014-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10151-013-1014-y

Keywords

Search

Navigation