Degree of blood loss during surgery for rectal cancer: a population‐based epidemiologic study of surgical complications and survival

Abstract

The hypothesis tested in this study was that major blood loss during surgery for rectal cancer increases the risk for surgical complications and for small bowel obstruction (SBO) as a result of adhesions or tumour recurrence, and reduces overall survival. Data were retrieved from the Uppsala/Örebro Regional Rectal Cancer Registry for all patients undergoing radical resection for rectal cancer during 1997-2003 (n=1843) and were matched against the Swedish National Patient Registry regarding surgery and admission for SBO. These patient records were scrutinized to determine the etiology of surgery for SBO. The registry was scrutinized for blood loss and other surgical complications associated with surgery. Uni- and multivariate Cox analysis and logistic regression were used. Ninety-four (5.1%) patients underwent surgery for SBO >30days after the index operation: 82 for adhesions and 12 for tumour recurrence. The volume of blood lost did not influence the risk of surgery for SBO as a result of adhesions, but blood loss above the median (≥800ml) increased the risk for surgery for SBO caused by tumour recurrence (hazard ratio=10.52; 95% CI: 1.36-81.51). Increased blood loss increased the risk of surgical complications (OR=1.78; 95% CI: 1.35-2.35 with blood loss of ≥450ml) but did not reduce overall survival. Irradiation before surgery increased blood loss, complications and admission for SBO. Major blood loss during surgery for rectal cancer increases the risk of later surgery for SBO caused by tumour recurrence and surgical complications, but overall survival is not affected.