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Leukocyte Depletion in Allogeneic Blood Transfusion Does Not Change the Negative Influence on Survival Following Transthoracic Resection for Esophageal Cancer

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Perioperative transfusion of allogeneic blood has been hypothesized to have an immunomodulatory effect and influence survival in several cancer types. This study evaluates the association between receipt of leucocyte-depleted and non-depleted allogeneic blood and survival following esophagectomy for cancer.

Methods

A retrospective analysis was performed including 291 patients with esophageal cancers who underwent transthoracic en bloc esophagectomy and extended mediastinal lymphadenectomy. Neoadjuvant chemoradiation was administered in 152 (52.2%) patients. Perioperative blood transfusions were quantified and the potential prognostic cutoff for transfused units was calculated according to LeBlanc.

Results

The median number of perioperative blood transfusions was 2 (0–24), and 106 patients (36.4%) received no transfusions. Patients with one or less blood transfusion showed a significantly improved survival compared to patients receiving more than one unit (p < 0.009). In multivariate analysis, blood transfusion categories showed significance (p < 0.015) next to pT, pN, pM category, and residual tumor categories (R-categories). Separate analysis of 183 patients treated after the mandatory introduction of leukocyte-depleted blood transfusions detected a strong tendency, but no significant difference in survival for patients getting one or less or more than one transfusion (p = 0.056). Receipt of leukocyte-depleted versus non-depleted units, however, had no influence on survival (p = 0.766).

Conclusions

The need for perioperative allogeneic blood transfusions is significantly associated with poorer survival following resection for esophageal cancer by univariate and multivariate analysis. Our data suggest that the reduction of leukocytes in allogeneic transfusions is not sufficient to overcome the negative influence on survival.

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Authors and Affiliations

  1. Department of Visceral and Vascular Surgery, University of Cologne, Cologne, Germany

    Frederike C. Ling, Arnulf H. Hoelscher, Daniel Vallböhmer, Daniel Schmidt & Elfriede Bollschweiler

  2. Institute of Transfusion Medicine, University of Cologne, Cologne, Germany

    Susanne Picker & Birgit S. Gathof

  3. Department of Visceral and Transplantation Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland

    Paul M. Schneider

Authors
  1. Frederike C. Ling
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  2. Arnulf H. Hoelscher
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  3. Daniel Vallböhmer
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  4. Daniel Schmidt
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  5. Susanne Picker
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  6. Birgit S. Gathof
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  7. Elfriede Bollschweiler
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  8. Paul M. Schneider
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Correspondence to Paul M. Schneider.

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Ling, F.C., Hoelscher, A.H., Vallböhmer, D. et al. Leukocyte Depletion in Allogeneic Blood Transfusion Does Not Change the Negative Influence on Survival Following Transthoracic Resection for Esophageal Cancer. J Gastrointest Surg 13, 581–586 (2009). https://doi.org/10.1007/s11605-008-0787-1

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  • DOI: https://doi.org/10.1007/s11605-008-0787-1

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