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Allogenic Blood Transfusion is Associated with Poor Perioperative and Long-Term Outcome in Esophageal Cancer

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Abstract

Background

Esophageal resection for cancer (EC) is still associated with considerable mortality and morbidity rates. Allogenic blood transfusion (aBT) is associated with poor short-term and long-term outcome in surgical oncology. We aimed to evaluate the effect of aBT in a homogeneous population of EC patients undergoing esophagectomy without perioperative treatment.

Methods

We analyzed 565 esophagectomies performed due to EC. Allogenic blood transfusion was correlated to clinicopathological parameters, perioperative mortality and morbidity as well as the long-term outcome. Results are presented as adjusted odds ratio (OR) or hazard ratio (HR) with 95 % confidence interval (95 % CI).

Results

Patients receiving aBT (aBT(+)) had no higher tumor stages or higher rates of lymph node metastasis (P = 0.65 and 0.17, respectively) compared to patients without aBT (aBT(−)). Allogenic blood transfusion was strongly associated with perioperative morbidity (OR 1.9, 95 % CI 1.1–3.5, P = 0.02) and mortality (OR 2.9, 95 % CI 1.0–8.6, P = 0.04). Tumor recurrence rate was significantly higher in aBT(+) patients (P = 0.001). The disease-free and overall survival were significantly longer in aBT(−) compared to aBT(+) patients (P = 0.016 and <0.001, respectively). Patients receiving aBT had almost doubled risk for tumor recurrence (HR 1.8, 95 % CI 1.2–2.5, P = 0.001) and death (HR 2.2, 95 % CI 1.5–3.2, P < 0.001).

Conclusion

Allogenic blood transfusion has a significant impact on the natural course of EC after complete resection. The poor short-term and long-term outcome warrants further evaluation of the underlying molecular mechanisms induced by allogenic blood transfusion in cancer patients.

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Abbreviations

aBT:

Allogenic blood transfusion

AC:

Adenocarcinoma

AJCC:

American Joint Committee on Cancer

autoBT:

Autologous blood transfusion

CD:

Cluster of differentiation

CI:

Confidence interval

DFS:

Disease-free survival

EC:

Esophageal cancer

HR:

Hazard ratio

OR:

Odds ratio

OS:

Overall survival

SCC:

Squamous cell carcinoma

TA:

Thoracoabdominal

TH:

Transhiatal

TRICC:

Transfusion requirements in critical care

WBC:

White blood cell

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Author notes

    Authors and Affiliations

    1. Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      Matthias Reeh, Tarik Ghadban, Josephine Dedow, Faik G. Uzunoglu, Michael Nentwich, Jakob R. Izbicki & Yogesh K. Vashist

    2. Department of Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      Eik Vettorazzi

    3. Department of Intensive Care, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

      Stefan Kluge

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    1. Matthias Reeh
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    Matthias Reeh, Tarik Ghadban and Josephine Dedow have contributed equally to this work and therefore share first authorship.

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    Reeh, M., Ghadban, T., Dedow, J. et al. Allogenic Blood Transfusion is Associated with Poor Perioperative and Long-Term Outcome in Esophageal Cancer. World J Surg 41, 208–215 (2017). https://doi.org/10.1007/s00268-016-3730-8

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