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Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma

Annals of Surgical Oncology volume 18, pages 1327–1334 (2011)Cite this article

Abstract

Background

The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival.

Methods

A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed.

Results

One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16 months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15 months; P = 0.033) and OS (14 vs. 20 months; P = 0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02–1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03–1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT.

Conclusions

Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities.

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Conflict of interest

The authors declare no conflict of interest.

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Affiliations

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

    Peter J. Kneuertz MD, Sameer H. Patel MD, Carrie K. Chu MD, Shishir K. Maithel MD, Juan M. Sarmiento MD, Keith A. Delman MD, Charles A. Staley III MD & David A. Kooby MD

  2. Department of Surgery/Division of Surgical Oncology, Winship Cancer Institute-Emory University, Atlanta, GA, USA

    David A. Kooby MD

Authors
  1. Peter J. Kneuertz MD
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  2. Sameer H. Patel MD
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  3. Carrie K. Chu MD
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  4. Shishir K. Maithel MD
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  5. Juan M. Sarmiento MD
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  6. Keith A. Delman MD
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  7. Charles A. Staley III MD
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  8. David A. Kooby MD
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Correspondence to David A. Kooby MD.

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Kneuertz, P.J., Patel, S.H., Chu, C.K. et al. Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma. Ann Surg Oncol 18, 1327–1334 (2011). https://doi.org/10.1245/s10434-010-1476-3

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  • DOI: https://doi.org/10.1245/s10434-010-1476-3

Keywords

  • Overall Survival
  • Major Postoperative Complication
  • Portal Vein Resection
  • Charlson Comorbidity Score
  • Preoperative Anemia