Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases

Abstract

Objective: To determine if transfusion affected perioperative and long-term outcome in patients undergoing liver resection for metastatic colorectal cancer.

Summary background data: Blood transfusion produces host immunosuppression and has been postulated to result in adverse outcome for patients undergoing surgical resection of malignancies.

Methods: Blood transfusion records and clinical outcomes for 1,351 patients undergoing liver resection at a tertiary cancer referral center were analyzed.

Results: Blood transfusion was associated with adverse outcome after liver resection. The greatest effect was in the perioperative course, where transfusion was an independent predictor of operative mortality, complications, major complications, and length of hospital stay. This effect was dose-related. Patients receiving one or two units or more than two units had an operative mortality of 2.5% and 11.1%, respectively, compared to 1.2% for patients not requiring transfusions. Transfusion was also associated with adverse long-term survival by univariate analysis, but this factor was not significant on multivariate analysis. Even patients receiving only one or two units had a more adverse outcome.

Conclusions: Perioperative blood transfusion is a risk factor for poor outcome after liver resection. Blood conservation methods should be used to avoid transfusion, especially in patents currently requiring limited amounts of transfused blood products.

Figure 1. Overall survival of all 1,351 patients undergoing liver resection for metastatic colorectal cancer.

Figure 2. Survival of patients undergoing liver resection for metastatic colorectal cancer stratified by transfusion status. (A) Data for all 1,351 patients (P = .0001). (B) Data from the 1,261 patients who survived the initial operative period (P = .009).

Figure 3. Survival of patients after liver resection for metastatic colorectal cancer stratified by amount of red blood cells (RBC) trans-fused. (A) Results for all 1,351 patients, grouped as: 1) no transfusion(n = 602), 2) 1 or 2 units transfused (n = 323), 3) 3 to 10 units transfused (n = 247), and 4) more than 10 units transfused (n = 52). P < .01 comparing all four curves (0, 1–2, 3–10, >10);P < .01 comparing only 3 to 10 and 10+. (B) Results for patients surviving beyond the perioperative period. P < .01 comparing all four curves (0, 1–2, 3–10, >10);P = .8 comparing only 3 to 10 and 10+.

Figure 4. Survival of patients who did not receive transfusion (solid line, n = 602) compared to those who only received autologous blood products (long dashed line, n = 86) and those who had one or two units of allogeneic blood (short dashed line, n = 322). P = .98, no transfusion versus autologous;P = .13, autologous versus one- or two-unit allogeneic.