Abstract
PurposeAllogeneic blood transfusions (BTF) are sometimes inevitable during radical gastrectomy with lymphadenectomy for advanced gastric cancer. The aim of this retrospective study was to investigate the association between BTF and post-operative infections, focusing on the impact of timing, amount of transfusion and the role of leukocyte depletion.MethodsThe study cohort was 2064 patients who underwent gastrectomy for gastric cancer from November 2010 to August 2017. The association between BTF and post-operative infections was estimated by univariate and multivariate analyses after propensity score matching. Subgroup analysis was performed according to the timing and amount of transfusion, and leukocyte depletion or not.ResultsOut of a total 2064 patients, 426 (20.6%) received peri-operative BTF. After one-to-one matching, 361 pairs of patients were included for further analysis, of who 68 (9.4%) developed infections. Multivariate analysis identified that an operation time ≥ 240 min, combined multi-organ resection, BTF and BMI ≥ 25 kg/m2 were independent risk factors for post-operative infection. Patients given a high-volume (> 7.5 U), intra-operatively of leukocyte-non-depleted BTF had the highest risk of developing infections clarified by subgroup analysis.ConclusionInfection was the most common complication following gastrectomy for gastric cancer and BTF was identified as an independent risk factor by propensity score matching and multivariate analyses. The timing, amount of transfusion and leukocyte depletion had an impact on the incidence of infection. To decrease infection, BTF should be avoided where possible, particularly during operation, with a large amount and leukocyte-not-depleted blood.
Highlights
Gastric cancer is the fourth most frequent cancer occurring worldwide and the second most common cause of cancerrelated mortality in China (Torre et al 2015; Chen et al 2016), with to date surgery as the only treatment that offersHua Xiao and Hu Quan contributed to this work.1 3 Vol.:(0123456789)Journal of Cancer Research and Clinical Oncology (2018) 144:1143–1154 techniques and peri-operative care (Ecker et al 2016)
Smoking appeared to influence the incidence of infection (OR = 1.597, 95% confidence interval P value (CI) 0.945–2.699), but the finding was not statistically significant (P = 0.080). No other variables such as comorbidities, total gastrectomy or splenectomy were identified as independent risk factors for infection. In this retrospective study of a large cohort of patients from a single high-volume center in China, after one-to-one propensity score matching we found that infection was the most common complication following radical gastrectomy for gastric cancer, leading to prolonged post-operative hospital stays (23.78 vs. 11.62 days, P < 0.001) and a higher frequency of requiring intensive care (17.6 vs 2.3%, P < 0.001) and mortality (8.8 vs 0.2%, P < 0.001)
Many studies have evaluated the impact of peri-operative blood transfusions (BTF) on postoperative outcomes of patients undergoing gastrectomy for gastric cancer, most of the conclusions were based on a limited number of patients and unmatched analysis
Summary
Gastric cancer is the fourth most frequent cancer occurring worldwide and the second most common cause of cancerrelated mortality in China (Torre et al 2015; Chen et al 2016), with to date surgery as the only treatment that offersHua Xiao and Hu Quan contributed to this work.1 3 Vol.:(0123456789)Journal of Cancer Research and Clinical Oncology (2018) 144:1143–1154 techniques and peri-operative care (Ecker et al 2016). While BTF may be vital in some circumstances, there is growing evidence that BTF is associated with adverse long-term survival in oncological patients These detrimental effects are thought to be associated with systemic inflammation and transfusion-related immunomodulation (TRIM) (Sun et al 2015; Squires et al 2015; Kanda et al 2016; Aquina et al 2017), while the relationships between BTF and post-operative short-term outcomes have been less well documented. The association of the transfusion timing, amount and the role of leukocyte depletion with post-operative infection that focused on patients who underwent gastrectomy for gastric cancer has rarely been studied. The present inquiry aimed to evaluate the potential impact of the timing, amount of transfusion and leukocyte depletion on post-operative infection after radical gastrectomy for gastric cancer by a propensity score-matching analysis using the database from a high volume center in China
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