Autologous Blood Transfusion for Esophageal Cancer Treated with Chemoradiotherapy Followed by Esophagectomy

Purpose: Autologous blood transfusion has been shown to be useful as a means of avoiding the problems associated with allogeneic transfusion, such as transmission of bacteria and viruses, and immunological reactions, such as allergy, graft-versus-host disease, and suppression of tumor immunity. This study retrospectively investigated the usefulness of autologous blood donation in esophageal cancer treated by chemoradiotherapy (CRT) followed by surgery. Patients and Methods: Between June 2000 and October 2003, 59 patientswith resectable esophageal cancer were treated by preoperative CRT, consisting of 5FU 700-800mg/m2 days1-5, Nedaplatin 80mg/m2 (or Cisplatin 70mg/m2) day 1, and 30Gy of radiation days 1-19. The criteria for autologous blood donation were: Hb value greater than 11g/dl, body weight greater than 40kg, and having obtained informed consent in writing. Autologous blood was collected 1 and 2 weeks before surgery, anderythropoietin was injected on the day of each blood donation. Esophagectomy was performed by right thoracotomy and laparotomy, and a cervical or intrathoracic anastomosis was created between the esophagus andgastric tube by the stapling technique. The autologous blood donor (ABD) group was compared with a nonautologous blood donor (NABD) group who were treated by the same preoperative CRT schedule and satisfied the criteria for autologous blood donation between Aug 1998 and May 2000. Results: The Hb value of 49 (83.1%) of the 59 patients treated by preoperative CRT was higher than 11g/dl, and 400-800ml (mean 662.2±158.5ml) of autologous blood was successfully collected from the 45 patients (76.3%) who weighed morethan 40kg. Allogeneic blood transfusion during the perioperative period was avoided in only 1 patient (9.1%) in the NABD group. In the ABD group, on the other hand, allogeneic blood products, including MAP, FFP and PPF, were avoided in 36 patients (83.7%). There were no significant differences between the twogroups in postoperative complications or Hb, serum total protein, and albumin values. Conclusion: These results indicate that autologous blood donation is useful as a means of avoiding allogeneic blood transfusion inesophageal cancer patients treated by preoperative CRT and surgery.