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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

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

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

    Alexandra G. Lopez-Aguiar MD, MS, Cecilia G. Ethun MD MS & Shishir K. Maithel MD

  2. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD

  3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    Thuy Tran MD & George A. Poultsides MD

  4. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea A. Isom MD & Kamran Idrees MD

  5. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    Bradley A. Krasnick MD & Ryan C. Fields MD

  6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Ahmed Salem MD & Sharon M. Weber MD

  7. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Robert C. G. Martin MD & Charles R. Scoggins MD

  8. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD & Harveshp D. Mogal MD

  9. Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Timothy M. Pawlik MD, MPH, PhD, Eliza W. Beal MD & Carl Schmidt MD

  10. Department of Surgery, New York University, New York, NY, USA

    Rivfka Shenoy MD & Ioannis Hatzaras MD

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  1. Alexandra G. Lopez-Aguiar MD, MS
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  2. Cecilia G. Ethun MD MS
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  19. Ioannis Hatzaras MD
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  20. Shishir K. Maithel MD
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Correspondence to Shishir K. Maithel MD.

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Lopez-Aguiar, A.G., Ethun, C.G., Pawlik, T.M. et al. Association of Perioperative Transfusion with Recurrence and Survival After Resection of Distal Cholangiocarcinoma: A 10-Institution Study from the US Extrahepatic Biliary Malignancy Consortium. Ann Surg Oncol 26, 1814–1823 (2019). https://doi.org/10.1245/s10434-019-07306-x

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