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Association of Perioperative Transfusion with Recurrence and Survival After Resection of Distal Cholangiocarcinoma: A 10-Institution Study from the US Extrahepatic Biliary Malignancy Consortium

  • Alexandra G. Lopez-Aguiar
  • Cecilia G. Ethun
  • Timothy M. Pawlik
  • Thuy Tran
  • George A. Poultsides
  • Chelsea A. Isom
  • Kamran Idrees
  • Bradley A. Krasnick
  • Ryan C. Fields
  • Ahmed Salem
  • Sharon M. Weber
  • Robert C. G. Martin
  • Charles R. Scoggins
  • Perry Shen
  • Harveshp D. Mogal
  • Eliza W. Beal
  • Carl Schmidt
  • Rivfka Shenoy
  • Ioannis Hatzaras
  • Shishir K. MaithelEmail author
Hepatobiliary Tumors
  • 20 Downloads

Abstract

Background

Perioperative allogeneic blood transfusion is associated with poor oncologic outcomes in multiple malignancies. The effect of blood transfusion on recurrence and survival in distal cholangiocarcinoma (DCC) is not known.

Methods

All patients with DCC who underwent curative-intent pancreaticoduodenectomy at 10 institutions from 2000 to 2015 were included. Primary outcomes were recurrence-free (RFS) and overall survival (OS).

Results

Among 314 patients with DCC, 191 (61%) underwent curative-intent pancreaticoduodenectomy. Fifty-three patients (28%) received perioperative blood transfusions, with a median of 2 units. There were no differences in baseline demographics or operative data between transfusion and no-transfusion groups. Compared with no-transfusion, patients who received a transfusion were more likely to have (+) margins (28 vs 14%; p = 0.034) and major complications (46 vs 16%; p < 0.001). Transfusion was associated with worse median RFS (19 vs 32 months; p = 0.006) and OS (15 vs 29 months; p = 0.003), which persisted on multivariable (MV) analysis for both RFS [hazard ratio (HR) 1.8; 95% confidence interval (CI) 1.1–3.0; p = 0.031] and OS (HR 1.9; 95% CI 1.1–3.3; p = 0.018), after controlling for portal vein resection, estimated blood loss (EBL), grade, lymphovascular invasion (LVI), and major complications. Similarly, transfusion of ≥ 2 pRBCs was associated with lower RFS (17 vs 32 months; p < 0.001) and OS (14 vs 29 months; p < 0.001), which again persisted on MV analysis for both RFS (HR 2.6; 95% CI 1.4–4.5; p = 0.001) and OS (HR 4.0; 95% CI 2.2–7.5; p < 0.001). The RFS and OS of patients transfused 1 unit was comparable to patients who were not transfused.

Conclusion

Perioperative blood transfusion is associated with decreased RFS and OS after resection for distal cholangiocarcinoma, after accounting for known adverse pathologic factors. Volume of transfusion seems to exert an independent effect, as 1 unit was not associated with the same adverse effects as ≥ 2 units.

Notes

Acknowledgment

Funding provided in part by the Katz Foundation. Supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR000454 and TL1TR000456. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Alexandra G. Lopez-Aguiar
    • 1
  • Cecilia G. Ethun
    • 1
  • Timothy M. Pawlik
    • 2
    • 9
  • Thuy Tran
    • 3
  • George A. Poultsides
    • 3
  • Chelsea A. Isom
    • 4
  • Kamran Idrees
    • 4
  • Bradley A. Krasnick
    • 5
  • Ryan C. Fields
    • 5
  • Ahmed Salem
    • 6
  • Sharon M. Weber
    • 6
  • Robert C. G. Martin
    • 7
  • Charles R. Scoggins
    • 7
  • Perry Shen
    • 8
  • Harveshp D. Mogal
    • 8
  • Eliza W. Beal
    • 9
  • Carl Schmidt
    • 9
  • Rivfka Shenoy
    • 10
  • Ioannis Hatzaras
    • 10
  • Shishir K. Maithel
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Department of SurgeryStanford University Medical CenterStanfordUSA
  4. 4.Division of Surgical Oncology, Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of SurgeryWashington University School of MedicineSt LouisUSA
  6. 6.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  7. 7.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  8. 8.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  9. 9.Division of Surgical OncologyThe Ohio State University Comprehensive Cancer CenterColumbusUSA
  10. 10.Department of SurgeryNew York UniversityNew YorkUSA

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