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The Impact of Perioperative Red Blood Cell Transfusions on Long-Term Outcomes after Hepatectomy for Colorectal Liver Metastases

Annals of Surgical Oncology volume 22, pages 4038–4045 (2015)Cite this article

Abstract

Background

Red blood cell transfusions (RBCTs) are associated with cancer recurrence following resection of colorectal cancer. Their impact after colorectal liver metastases (CRLM) resection remains debated. We sought to explore the association between perioperative RBCT and oncologic outcomes following resection of CRLM.

Methods

We reviewed patients undergoing partial hepatectomy for CRLM from 2003 to 2012 at a single institution. Date of death was abstracted from a validated population-based cancer registry. Primary outcome was overall survival (OS). Secondary outcome was recurrence-free survival (RFS). Survivals were estimated using Kaplan–Meier methods and compared with log-rank test based on transfusion status. Cox regression analysis examined the association of RBCT with OS and RFS, while adjusting for age, preoperative chemotherapy, Clinical Risk Score, and period of treatment (2003–2007 vs. 2008–2012).

Results

Among 483 patients, 27.5 % received RBCT. Ninety-day postoperative mortality was 4.8 %. At median follow-up of 33 (interquartile range 20.1–54.8) months, 5-year OS was inferior in transfused patients (45.9 vs. 61.0 %; p < 0.0001). Five-year RFS was decreased with RBCT (15.5 vs. 31.6 %; p < 0.0001). The difference persisted when considering only 90-day survivors for 5-year OS (53.1 vs. 61.9 %, p = 0.023) and RFS (15.6 vs. 31.6 %; p < 0.0001). After adjustment for prognostic factors, RBCT was independently associated with decreased OS (hazard ratio 2.24; 95 % confidence interval 1.60–3.15) and RFS (hazard ratio 1.71; 95 % confidence interval 1.28–2.28).

Conclusions

Perioperative RBCT is independently associated with decreased OS and RFS following hepatectomy for CRLM. Interventions to minimize and rationalize the use of RBCT for hepatectomy are warranted to mitigate this detrimental effect on long-term outcomes.

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Acknowledgment

The authors thank Ms. Jessica Truong for her assistance with data collection. No funding was received for this work.

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Affiliations

  1. Division of General Surgery, Sunnybrook Health Sciences Centre – Odette Cancer Centre, Toronto, ON, Canada

    Julie Hallet, Melanie Tsang, Eva S. W. Cheng, Rogeh Habashi, Iryna Kulyk, Sherif S. Hanna, Natalie G. Coburn, Calvin H. L. Law & Paul J. Karanicolas

  2. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Julie Hallet, Melanie Tsang, Sherif S. Hanna, Natalie G. Coburn, Calvin H. L. Law & Paul J. Karanicolas

  3. Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Yulia Lin

  4. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

    Yulia Lin

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  1. Julie Hallet
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  2. Melanie Tsang
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Correspondence to Julie Hallet.

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Hallet, J., Tsang, M., Cheng, E.S.W. et al. The Impact of Perioperative Red Blood Cell Transfusions on Long-Term Outcomes after Hepatectomy for Colorectal Liver Metastases. Ann Surg Oncol 22, 4038–4045 (2015). https://doi.org/10.1245/s10434-015-4477-4

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  • DOI: https://doi.org/10.1245/s10434-015-4477-4

Keywords

  • Overall Survival
  • Liver Resection
  • Colorectal Liver Metastasis
  • Clinical Risk Score
  • Transfuse Patient