Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma
Background The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and...
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| Veröffentlicht in: | Annals of surgical oncology 2011-05, Vol.18 (5), p.1327-1334 |
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| container_title | Annals of surgical oncology |
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| creator | Kneuertz, Peter J. Patel, Sameer H. Chu, Carrie K. Maithel, Shishir K. Sarmiento, Juan M. Delman, Keith A. Staley, Charles A. Kooby, David A. |
| description | Background
The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival.
Methods
A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed.
Results
One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16 months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15 months;
P
= 0.033) and OS (14 vs. 20 months;
P
= 0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02–1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03–1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT.
Conclusions
Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities. |
| doi_str_mv | 10.1245/s10434-010-1476-3 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_862604194</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>862604194</sourcerecordid><originalsourceid>FETCH-LOGICAL-c436t-89b6d8bd0d41503c3dba9e01344dac102c6fd90cd4e5116a1b582372b3873e293</originalsourceid><addsrcrecordid>eNp1kdFqFTEQhkOp2Fp9gN5I6E2vVjNJNrt7Wc9pVShYtF4v2WQiW3aTY7I50JfwmZvlVAVBCCQz880_GX5CzoG9Ay7r9wmYFLJiwCqQjarEETmFumSkauG4vJlqq46r-oS8SumBMWgEq1-SEw5CdY2Up-TXtXNolkSDo3cYx7DDqJdxj_QrWvphCsHSDU4TvY_aJ5fTGDwtZzsm1GmlTI4RvUGqvaXfctyPez3RK7dgpHfam4hFzwSbg0VfRoX5kboQ6TabZQVLNhgdzejDrF-TF05PCd8832fk-831_eZTdfvl4-fN1W1lpFBL1XaDsu1gmZVQM2GEHXSHDISUVhtg3ChnO2asxBpAaRjqlouGD6JtBPJOnJHLg-4uhp8Z09LPYzJlT-0x5NS3iismoZOFvPiHfAg5-vK5FVptELxAcIBMDClFdP0ujrOOjz2wfmX6g1U9W-NiVS9Kz9tn4TzMaP90_PamAPwApFLyPzD-nfx_1SfWzKAO</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>862124532</pqid></control><display><type>article</type><title>Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Kneuertz, Peter J. ; Patel, Sameer H. ; Chu, Carrie K. ; Maithel, Shishir K. ; Sarmiento, Juan M. ; Delman, Keith A. ; Staley, Charles A. ; Kooby, David A.</creator><creatorcontrib>Kneuertz, Peter J. ; Patel, Sameer H. ; Chu, Carrie K. ; Maithel, Shishir K. ; Sarmiento, Juan M. ; Delman, Keith A. ; Staley, Charles A. ; Kooby, David A.</creatorcontrib><description>Background
The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival.
Methods
A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed.
Results
One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16 months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15 months;
P
= 0.033) and OS (14 vs. 20 months;
P
= 0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02–1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03–1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT.
Conclusions
Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-010-1476-3</identifier><identifier>PMID: 21369744</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adenocarcinoma - mortality ; Adenocarcinoma - pathology ; Adenocarcinoma - therapy ; Adult ; Aged ; Aged, 80 and over ; Carcinoma, Pancreatic Ductal - mortality ; Carcinoma, Pancreatic Ductal - pathology ; Carcinoma, Pancreatic Ductal - therapy ; Cohort Studies ; Combined Modality Therapy ; Erythrocyte Transfusion ; Female ; Follow-Up Studies ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Recurrence, Local - diagnosis ; Neoplasm Recurrence, Local - mortality ; Neoplasm Recurrence, Local - therapy ; Oncology ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - therapy ; Pancreatic Tumors ; Pancreaticoduodenectomy ; Perioperative Care ; Postoperative Complications ; Prospective Studies ; Surgery ; Surgical Oncology ; Survival Rate ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2011-05, Vol.18 (5), p.1327-1334</ispartof><rights>Society of Surgical Oncology 2011</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c436t-89b6d8bd0d41503c3dba9e01344dac102c6fd90cd4e5116a1b582372b3873e293</citedby><cites>FETCH-LOGICAL-c436t-89b6d8bd0d41503c3dba9e01344dac102c6fd90cd4e5116a1b582372b3873e293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-010-1476-3$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-010-1476-3$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27922,27923,41486,42555,51317</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21369744$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kneuertz, Peter J.</creatorcontrib><creatorcontrib>Patel, Sameer H.</creatorcontrib><creatorcontrib>Chu, Carrie K.</creatorcontrib><creatorcontrib>Maithel, Shishir K.</creatorcontrib><creatorcontrib>Sarmiento, Juan M.</creatorcontrib><creatorcontrib>Delman, Keith A.</creatorcontrib><creatorcontrib>Staley, Charles A.</creatorcontrib><creatorcontrib>Kooby, David A.</creatorcontrib><title>Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival.
Methods
A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed.
Results
One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16 months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15 months;
P
= 0.033) and OS (14 vs. 20 months;
P
= 0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02–1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03–1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT.
Conclusions
Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities.</description><subject>Adenocarcinoma - mortality</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - therapy</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carcinoma, Pancreatic Ductal - mortality</subject><subject>Carcinoma, Pancreatic Ductal - pathology</subject><subject>Carcinoma, Pancreatic Ductal - therapy</subject><subject>Cohort Studies</subject><subject>Combined Modality Therapy</subject><subject>Erythrocyte Transfusion</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - diagnosis</subject><subject>Neoplasm Recurrence, Local - mortality</subject><subject>Neoplasm Recurrence, Local - therapy</subject><subject>Oncology</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - therapy</subject><subject>Pancreatic Tumors</subject><subject>Pancreaticoduodenectomy</subject><subject>Perioperative Care</subject><subject>Postoperative Complications</subject><subject>Prospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kdFqFTEQhkOp2Fp9gN5I6E2vVjNJNrt7Wc9pVShYtF4v2WQiW3aTY7I50JfwmZvlVAVBCCQz880_GX5CzoG9Ay7r9wmYFLJiwCqQjarEETmFumSkauG4vJlqq46r-oS8SumBMWgEq1-SEw5CdY2Up-TXtXNolkSDo3cYx7DDqJdxj_QrWvphCsHSDU4TvY_aJ5fTGDwtZzsm1GmlTI4RvUGqvaXfctyPez3RK7dgpHfam4hFzwSbg0VfRoX5kboQ6TabZQVLNhgdzejDrF-TF05PCd8832fk-831_eZTdfvl4-fN1W1lpFBL1XaDsu1gmZVQM2GEHXSHDISUVhtg3ChnO2asxBpAaRjqlouGD6JtBPJOnJHLg-4uhp8Z09LPYzJlT-0x5NS3iismoZOFvPiHfAg5-vK5FVptELxAcIBMDClFdP0ujrOOjz2wfmX6g1U9W-NiVS9Kz9tn4TzMaP90_PamAPwApFLyPzD-nfx_1SfWzKAO</recordid><startdate>20110501</startdate><enddate>20110501</enddate><creator>Kneuertz, Peter J.</creator><creator>Patel, Sameer H.</creator><creator>Chu, Carrie K.</creator><creator>Maithel, Shishir K.</creator><creator>Sarmiento, Juan M.</creator><creator>Delman, Keith A.</creator><creator>Staley, Charles A.</creator><creator>Kooby, David A.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope></search><sort><creationdate>20110501</creationdate><title>Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma</title><author>Kneuertz, Peter J. ; 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The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival.
Methods
A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed.
Results
One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16 months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15 months;
P
= 0.033) and OS (14 vs. 20 months;
P
= 0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02–1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03–1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT.
Conclusions
Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>21369744</pmid><doi>10.1245/s10434-010-1476-3</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2011-05, Vol.18 (5), p.1327-1334 |
| issn | 1068-9265 1534-4681 |
| language | eng |
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| subjects | Adenocarcinoma - mortality Adenocarcinoma - pathology Adenocarcinoma - therapy Adult Aged Aged, 80 and over Carcinoma, Pancreatic Ductal - mortality Carcinoma, Pancreatic Ductal - pathology Carcinoma, Pancreatic Ductal - therapy Cohort Studies Combined Modality Therapy Erythrocyte Transfusion Female Follow-Up Studies Humans Male Medicine Medicine & Public Health Middle Aged Neoplasm Recurrence, Local - diagnosis Neoplasm Recurrence, Local - mortality Neoplasm Recurrence, Local - therapy Oncology Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - therapy Pancreatic Tumors Pancreaticoduodenectomy Perioperative Care Postoperative Complications Prospective Studies Surgery Surgical Oncology Survival Rate Treatment Outcome |
| title | Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma |
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