Transfusion requirements in surgical oncology patients

Almeida JP, et al.: Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Anesthesiology. 2015 Jan;122(1):29-38.

  • There is no evidence that restrictive rather than liberal erythrocyte transfusion strategy is superior in cancer patients
  • Randomized, controlled, parallel-group, double-blind (patients and outcome assessors) superiority trial
  • Restrictive strategy of erythrocyte transfusion (Hb <7 g/dl) vs. liberal (Hb <9 g/dl)
  • Primary outcome: composite endpoint of mortality and morbidity
  • 198 patients were included => 101 in the restrictive group and 97 in the liberal group.
  • The primary composite endpoint for liberal: 19.6% (95% CI, 12.9 to 28.6%) vs. for restrictive: 35.6% (27.0 to 45.4%), P = 0.012
  • Liberal transfusion => absolute risk reduction for the composite outcome of 16% (3.8 to 28.2%) and a number needed to treat of 6.2 (3.5 to 26.5)
  • Liberal erythrocyte transfusion strategy (Hb< 9 g/dl vs. restrictive Hb<7 g/dl) was associated with fewer major postoperative complications in cancer patients

Mörner ME, et al.: Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study. Int J Colorectal Dis. 2016 Oct 21

  • Anaemia prior to surgery and perioperative red blood cell transfusion increases the risk for recurrence and overall mortality in patients with stages I-III colorectal cancer after abdominal resection with curative intent
  • Single centre retrospective cohort study / Swedish Colorectal Cancer Registry
  • 496 consecutive radical abdominal resections stages I-III colorectal cancer
  • Multivariate Cox regression analysis assessed risk for cancer recurrence and overall mortality
  • Anaemia prior to surgery was associated with increased risk for overall mortality (HR 2.1, 95% CI 1.4-3.2).
  • No association between anaemia and risk for cancer recurrence (HR 1.6, 95% CI 0.97-2.6)
  • Transfusion was not associated with increased risk of cancer recurrence (HR 0.7, 95% CI 0.4-1.3) or overall mortality (HR 1.04, 95% CI 0.7-1.6)
  • Anaemia prior to colorectal cancer surgery was associated with increased risk for overall mortality
  • Previous findings indicating an association between blood transfusion and increased risk for recurrence could not be confirmed

Reeh M, et al.: Allogenic Blood Transfusion is Associated with Poor Perioperative and Long-Term Outcome in Esophageal Cancer. World J Surg. 2016 Oct 11

  • Allogenic blood transfusion (aBT) is associated with poor short-term and long-term outcome in surgical oncology
  • This study tests the effect of aBT in a homogeneous population of esophageal cancer (EC) patients undergoing esophagectomy without perioperative treatment
  • 565 esophagectomies performed due to EC
  • Allogenic blood transfusion (aBT) 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)
  • Allogenic blood transfusion has a significant impact on the natural course of EC after complete resection
  • Underlying molecular mechanisms induced by allogenic blood transfusion in cancer patients

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