Yuki Ito1, Mitsuro Kanda2, Seiji Ito3, Yoshinari Mochizuki4, Hitoshi Teramoto5, Kiyoshi Ishigure6, Toshifumi Murai7, Takahiro Asada1, Akiharu Ishiyama8, Hidenobu Matsushita9, Chie Tanaka10, Daisuke Kobayashi10, Michitaka Fujiwara10, Kenta Murotani11, Yasuhiro Kodera10. 1. Department of Surgery, Gifu Prefectural Tajimi Hospital, Tajimi, Japan. 2. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. m-kanda@med.nagoya-u.ac.jp. 3. Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Japan. 4. Department of Surgery, Komaki Municipal Hospital, Komaki, Japan. 5. Department of Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan. 6. Department of Surgery, Konan Kosei Hospital, Konan, Japan. 7. Department of Surgery, Ichinomiya Municipal Hospital, Ichinomiya, Japan. 8. Department of Surgery, Okazaki City Hospital, Okazaki, Japan. 9. Department of Surgery, Tosei General Hospital, Seto, Japan. 10. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan. 11. Biostatistics Center, Graduate School of Medicine, Kurume University, Kurume, Japan.
Abstract
BACKGROUND: The influence of intraoperative blood loss (IBL) on postoperative long-term outcomes of patients with gastric cancer is controversial. Here, we used a large multicenter dataset from nine institutes to evaluate the prognostic impact of IBL on patients with stage II/III gastric cancer. METHODS: The study analyzed 1013 patients with stage II/III gastric cancer who underwent gastrectomy without preoperative treatment and intraoperative transfusion. Patients were equally divided into learning and validation cohorts using a table of random numbers. The optimal cutoff value of IBL to predict recurrence was determined using the learning cohort, and the prognostic significance of the proposed cutoff was validated using the second cohort. RESULTS: The optimal cutoff value of IBL determined with the learning cohort using the receiver operating characteristic curve analysis was 330 ml. In the validation cohort, IBL > 330 ml was significantly associated with high body mass index, total gastrectomy, and postoperative complications, but not disease stage and the frequency of adjuvant chemotherapy. The disease-free and disease-specific survival rates of patients in the IBL > 330 ml (IBL-high) group were significantly shorter compared with those in the IBL ≤ 330 ml group. IBL-high was identified as an independent prognostic factor of disease recurrence (hazard ratio 1.45, 95% confidence interval 1.01-2.09, P = 0.0420). The hazard ratio of the IBL-high group was greater in the surgery-alone subgroup compared with that of the postoperative adjuvant-chemotherapy subgroup. CONCLUSIONS: Our analysis of a multicenter dataset indicates that IBL adversely influenced long-term outcomes of patients with stage II/III gastric cancer.
BACKGROUND: The influence of intraoperative blood loss (IBL) on postoperative long-term outcomes of patients with gastric cancer is controversial. Here, we used a large multicenter dataset from nine institutes to evaluate the prognostic impact of IBL on patients with stage II/III gastric cancer. METHODS: The study analyzed 1013 patients with stage II/III gastric cancer who underwent gastrectomy without preoperative treatment and intraoperative transfusion. Patients were equally divided into learning and validation cohorts using a table of random numbers. The optimal cutoff value of IBL to predict recurrence was determined using the learning cohort, and the prognostic significance of the proposed cutoff was validated using the second cohort. RESULTS: The optimal cutoff value of IBL determined with the learning cohort using the receiver operating characteristic curve analysis was 330 ml. In the validation cohort, IBL > 330 ml was significantly associated with high body mass index, total gastrectomy, and postoperative complications, but not disease stage and the frequency of adjuvant chemotherapy. The disease-free and disease-specific survival rates of patients in the IBL > 330 ml (IBL-high) group were significantly shorter compared with those in the IBL ≤ 330 ml group. IBL-high was identified as an independent prognostic factor of disease recurrence (hazard ratio 1.45, 95% confidence interval 1.01-2.09, P = 0.0420). The hazard ratio of the IBL-high group was greater in the surgery-alone subgroup compared with that of the postoperative adjuvant-chemotherapy subgroup. CONCLUSIONS: Our analysis of a multicenter dataset indicates that IBL adversely influenced long-term outcomes of patients with stage II/III gastric cancer.
Authors: Alvina Jada Fok; Wong Hoi She; Ka Wing Ma; Simon H Y Tsang; Wing Chiu Dai; Albert C Y Chan; Chung Mau Lo; Tan To Cheung Journal: Langenbecks Arch Surg Date: 2021-08-18 Impact factor: 2.895