Lauren M Postlewait1, Malcolm H Squires1, David A Kooby1, Sharon M Weber2, Charles R Scoggins3, Kenneth Cardona1, Clifford S Cho2, Robert C G Martin3, Emily R Winslow2, Shishir K Maithel4. 1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 2. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. 3. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA. 4. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. Electronic address: smaithe@emory.edu.
Abstract
BACKGROUND: Data on prognostic implications of peri-operative blood transfusion around resection of colorectal cancer liver metastases (CRLM) are conflicting. This retrospective study assesses the association of transfusion with complications and disease-specific survival (DSS). METHODS: Major hepatectomies for CRLM from 2000 to 2010 at three institutions were included. Transfusion was analyzed based on timing and volume. RESULTS: Of 456 patients, 140 (30.7%) received transfusions. Transfusion was associated with extended hepatectomy (28.6 vs 18.4%; p = 0.020), tumor size (5.7 vs 4.2 cm; p < 0.001), and operative blood loss (917 vs 390 mL; p < 0.001). Transfusion was independently associated with major complications (OR 2.61; 95% CI: 1.53-4.44; p < 0.001). Transfusion at any time was not associated with DSS; however, patients who specifically received blood post-operatively had reduced DSS (37.4 vs 42.7 months; p = 0.044). Increased volume of transfusion (≥3 units) was also associated with shortened DSS (Total: 37.4 vs 41.5 months, p = 0.018; Post-operative: 27.2 vs 40.3 months, p = 0.015). On multivariate analysis, however, transfusion was not independently associated with worsened DSS, regardless of timing and volume. CONCLUSION: Transfusion with major hepatectomy for colorectal cancer metastases is independently associated with increased complications but not disease-specific survival. Judicious use of transfusion per a blood utilization protocol in the peri-operative period is warranted.
BACKGROUND: Data on prognostic implications of peri-operative blood transfusion around resection of colorectal cancer liver metastases (CRLM) are conflicting. This retrospective study assesses the association of transfusion with complications and disease-specific survival (DSS). METHODS: Major hepatectomies for CRLM from 2000 to 2010 at three institutions were included. Transfusion was analyzed based on timing and volume. RESULTS: Of 456 patients, 140 (30.7%) received transfusions. Transfusion was associated with extended hepatectomy (28.6 vs 18.4%; p = 0.020), tumor size (5.7 vs 4.2 cm; p < 0.001), and operative blood loss (917 vs 390 mL; p < 0.001). Transfusion was independently associated with major complications (OR 2.61; 95% CI: 1.53-4.44; p < 0.001). Transfusion at any time was not associated with DSS; however, patients who specifically received blood post-operatively had reduced DSS (37.4 vs 42.7 months; p = 0.044). Increased volume of transfusion (≥3 units) was also associated with shortened DSS (Total: 37.4 vs 41.5 months, p = 0.018; Post-operative: 27.2 vs 40.3 months, p = 0.015). On multivariate analysis, however, transfusion was not independently associated with worsened DSS, regardless of timing and volume. CONCLUSION: Transfusion with major hepatectomy for colorectal cancer metastases is independently associated with increased complications but not disease-specific survival. Judicious use of transfusion per a blood utilization protocol in the peri-operative period is warranted.
Authors: Michael A Choti; James V Sitzmann; Marcelo F Tiburi; Wuthi Sumetchotimetha; Ram Rangsin; Richard D Schulick; Keith D Lillemoe; Charles J Yeo; John L Cameron Journal: Ann Surg Date: 2002-06 Impact factor: 12.969
Authors: William R Jarnagin; Mithat Gonen; Yuman Fong; Ronald P DeMatteo; Leah Ben-Porat; Sarah Little; Carlos Corvera; Sharon Weber; Leslie H Blumgart Journal: Ann Surg Date: 2002-10 Impact factor: 12.969
Authors: John Wehry; Robert Cannon; Charles R Scoggins; Lisa Puffer; Kelly M McMasters; Robert C G Martin Journal: Am J Surg Date: 2014-08-06 Impact factor: 2.565
Authors: David A Kooby; Jennifer Stockman; Leah Ben-Porat; Mithat Gonen; William R Jarnagin; Ronald P Dematteo; Scott Tuorto; David Wuest; Leslie H Blumgart; Yuman Fong Journal: Ann Surg Date: 2003-06 Impact factor: 12.969
Authors: Caroline E Poorman; Lauren M Postlewait; Cecilia G Ethun; Thuy B Tran; Jason D Prescott; Timothy M Pawlik; Tracy S Wang; Jason Glenn; Ioannis Hatzaras; Rivfka Shenoy; John E Phay; Kara Keplinger; Ryan C Fields; Linda X Jin; Sharon M Weber; Ahmed Salem; Jason K Sicklick; Shady Gad; Adam C Yopp; John C Mansour; Quan-Yang Duh; Natalie Seiser; Carmen C Solorzano; Colleen M Kiernan; Konstantinos I Votanopoulos; Edward A Levine; Charles A Staley; George A Poultsides; Shishir K Maithel Journal: Am Surg Date: 2017-07-01 Impact factor: 0.688
Authors: Raphael Shamavonian; Rohan McLachlan; Oliver M Fisher; Sarah J Valle; Nayef A Alzahrani; Winston Liauw; David L Morris Journal: J Gastrointest Oncol Date: 2019-04
Authors: Mariana I Chavez; Sepideh Gholami; Bradford J Kim; Georgios A Margonis; Cecilia G Ethun; Susan Tsai; Kathleen K Christians; Callisia Clarke; Harveshp Mogal; Shishir K Maithel; Timothy M Pawlik; Michael I D'Angelica; Thomas A Aloia; Daniel Eastwood; T Clark Gamblin Journal: Ann Surg Oncol Date: 2021-01-03 Impact factor: 5.344