Kazunari Misawa1, Yukinori Kurokawa2, Junki Mizusawa3, Shuji Takiguchi2, Yuichiro Doki2, Shigeto Makino4, Yasuhiro Choda5, Atsushi Takeno6, Masanori Tokunaga7, Takeshi Sano8, Mitsuru Sasako9, Takaki Yoshikawa10, Masanori Terashima11. 1. Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, 464-8681, Japan. misawakzn@aichi-cc.jp. 2. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan. 3. Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan. 4. Department of Surgery, Nagaoka Chuo General Hospital, Nagaoka, Japan. 5. Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan. 6. Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan. 7. Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 8. Department of Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan. 9. Department of Surgery, Yodogawa Christian Hospital, Osaka, Japan. 10. Department of Gastric Surgery, National Cancer Centre Hospital, Tokyo, Japan. 11. Department of Gastric Surgery, Shizuoka Cancer Centre, Mishima, Japan.
Abstract
BACKGROUND: Recent retrospective studies have shown that increased intraoperative blood loss (IBL) during curative gastrectomy for patients with advanced gastric cancer is a negative prognostic indicator for recurrence. However, there are no reliable reports assessing this with a large-scale prospective cohort. This study aimed to evaluate the impact of IBL on long-term outcomes using data from the JCOG1001 phase III trial, which was designed to determine if bursectomy led to improved survival vs. nonbursectomy in patients with cT3/4a gastric cancer. METHODS: This study included 1203 of the 1204 patients enrolled in the JCOG1001. From the tertiles of IBL (196 ml, 400 ml), we divided the patients into three groups: IBL < 200 ml representing small blood loss (SBL, n = 404), 200 ml ≤ IBL < 400 ml representing medium blood loss (MBL, n = 393), and IBL ≥ 400 ml representing large blood loss (LBL, n = 406). The impact of IBL on relapse-free survival (RFS) was evaluated with univariable comparisons and multivariable Cox regression analyses. RESULTS: Three-year RFS after SBL, MBL, and LBL was 81.7%, 74.8%, and 70.6%, respectively. Multivariable analysis identified IBL, Eastern Cooperative Oncology Group performance status, pT, pN, and postoperative adjuvant chemotherapy as independent predictors of RFS. Compared with SBL as a reference, the hazard ratios of MBL and LBL were 1.461 (P = 0.012) and 1.520 (P = 0.009), respectively. CONCLUSIONS: Based on the analysis of data from a large-scale prospective study, an IBL of ≥ 200 ml after curative surgery for patients with cT3/4a gastric cancer was an independent predictor of reduced RFS.
BACKGROUND: Recent retrospective studies have shown that increased intraoperative blood loss (IBL) during curative gastrectomy for patients with advanced gastric cancer is a negative prognostic indicator for recurrence. However, there are no reliable reports assessing this with a large-scale prospective cohort. This study aimed to evaluate the impact of IBL on long-term outcomes using data from the JCOG1001 phase III trial, which was designed to determine if bursectomy led to improved survival vs. nonbursectomy in patients with cT3/4a gastric cancer. METHODS: This study included 1203 of the 1204 patients enrolled in the JCOG1001. From the tertiles of IBL (196 ml, 400 ml), we divided the patients into three groups: IBL < 200 ml representing small blood loss (SBL, n = 404), 200 ml ≤ IBL < 400 ml representing medium blood loss (MBL, n = 393), and IBL ≥ 400 ml representing large blood loss (LBL, n = 406). The impact of IBL on relapse-free survival (RFS) was evaluated with univariable comparisons and multivariable Cox regression analyses. RESULTS: Three-year RFS after SBL, MBL, and LBL was 81.7%, 74.8%, and 70.6%, respectively. Multivariable analysis identified IBL, Eastern Cooperative Oncology Group performance status, pT, pN, and postoperative adjuvant chemotherapy as independent predictors of RFS. Compared with SBL as a reference, the hazard ratios of MBL and LBL were 1.461 (P = 0.012) and 1.520 (P = 0.009), respectively. CONCLUSIONS: Based on the analysis of data from a large-scale prospective study, an IBL of ≥ 200 ml after curative surgery for patients with cT3/4a gastric cancer was an independent predictor of reduced RFS.