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Perioperative Allogenic Blood Transfusions Significantly Affect Survival Following Transthoracic En Bloc Resection for Esophageal Cancer
Daniel Vallbohmer*1, Frederike C. Ling1, Daniel Schmidt1, Roland Grunenberg2, Birgit S. Gathof2, Elfriede Bollschweiler1, Arnulf H. Hoelscher1, Paul M. Schneider1,3
1Department of Surgery, University of Cologne, Cologne, Germany; 2Institute of Transfusion Medicine, University of Cologne, Cologne, Germany; 3Department of Visceral and Transplantation Surgery, University of Zurich, Zurich, Switzerland
Background: Recent studies suggest that the number of transfused allogenic blood in the surgical therapy of gastrointestinal tumors significantly correlates with survival. The aim of this study was to evaluate the prognostic influence of allogenic blood transfusions following resection for esophageal cancer.
Methods: A retrospective analysis (1997-2006) was performed including 305 patients (median age 59.8 years) with esophageal cancers who underwent transthoracic en bloc esophagectomy and 2-field lymphadenectomy. Squamous cell cancer was found in 46.9% and adenocarcinoma in 50.5% (2.6% rare histologies). Neoadjuvant chemoradiation was performed in 159 (52%) patients. Number of perioperative blood transfusions were determined and the potential prognostic cut-off for transfused units was calculated according to LeBlanc.
Results: The median number of perioperative blood transfusions was 2 (range 0-53). 107 patients (35.2%) received no transfusions. One hundred-eighteen patients were treated before and 187 patients after the legally mandatory introduction of leukocyte-depleted blood. Patients with ≤ 1 blood transfusion showed a significant survival benefit compared to patients receiving > 1 unit (p<0.02). Multivariate analysis in R0 resected tumors demonstrated that in addition to the pTNM categories (pT:p<0.002, pN:p<0001,pM:p<0.02), perioperative blood transfusions (≤ 1 versus >1) were an independent prognostic factor (p<0.05). There was no difference in survival for patients getting none versus one unit or more and there was no detectable influence of leucocyte-depleted versus non-depleted units (p=0.28).
Conclusions: The number of perioperative allogenic blood transfusions appear to be an independent factor for survival after R0 resections by transthoracic en bloc esophagectomy for esophageal cancer. The prognostic influence of leucocyte-depleted blood deserves further evaluation due to a shorter observation time and the observation that there was no difference between patients getting none or one unit of blood in our retrospective analysis.
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