Abstract
Backgrounds: Investigate whether intraoperative transfusion is a negative prognostic factor for oncologic outcomes of resected pancreatic cancer. Methods: From June 2004 to January 2014, the medical records of 305 patients were retrospectively reviewed, who underwent pancreatoduodenectomy, pylorus preserving pancreatoduodenectomy, total pancreatectomy, distal pancreatectomy for pancreatic cancer. Patients diagnosed with metastatic disease (n = 3) and locally advanced diseases (n = 15) were excluded during the analysis, and total of 287 patients were analyzed. Results: The recurrence and disease-specific survival rates of the patients who received intraoperative transfusion showed poorer survival outcomes compared to those who did not (P = 0.031, P = 0.010). Through multivariate analysis, T status (HR (hazard ratio) = 2.04, [95% CI (confidence interval): 1.13–3.68], P = 0.018), N status (HR = 1.46 [95% CI: 1.00–2.12], P = 0.045), adjuvant chemotherapy (HR = 0.51, [95% CI: 0.35–0.75], P = 0.001), intraoperative transfusion (HR = 1.94 [95% CI: 1.23–3.07], P = 0.004) were independent prognostic factors of disease-specific survival after surgery. As well, adjuvant chemotherapy (HR = 0.67, [95% CI: 0.46–0.97], P = 0.035) was independently associated with tumor recurrence. Estimated blood loss was one of the most powerful factors associated with intraoperative transfusion (P < 0.001). Conclusions: Intraoperative transfusion can be considered as an independent prognostic factor of resected pancreatic cancer. As well, it can be avoided by following strict transfusion policy and using advanced surgical techniques to minimize bleeding during surgery.
Highlights
Pancreatic cancer is an aggressive disease with poor prognosis
The analysis showed that T status (HR = 2.04, [95% CI: 1.13–3.68], P = 0.018), N status (HR = 1.46 [95% CI: 1.00–2.12], P = 0.045), Adj.Adjuvant chemotherapy (CTx) (HR = 0.51, [95% CI: 0.35–0.75], P = 0.001), intraoperative transfusion (IOT) (HR = 1.94 [95% CI: 1.23–3.07], P = 0.004), were independent prognostic factors of disease-specific survival after surgery (Table 3)
The 5-year survival rate of overall pancreatic cancer is still 9%, and even for the small portion of people who are diagnosed with localized tumor and deemed operable, the 5-year survival is only 37% which is very poor compared with other types of tumors [2,16]
Summary
Pancreatic cancer is an aggressive disease with poor prognosis. Due to its tendency to remain asymptomatic until it reaches an advanced stage, it is difficult to diagnose and typically deemed unresectable at the time of diagnosis. Factors concerning poor prognosis of pancreatic cancers include high level of CA19-9, large tumor size, lymph node metastasis, and perineural and lymphovascular invasion [3,4,5,6] These factors cannot be controlled by surgeons and occur before pancreatectomy is performed. Adjuvant chemotherapy and radiotherapy can be performed after surgery, we decided to manipulate the timeline of surgery Factors such as availability of combined resection, operation time, amount of blood loss, and availability of transfusion are decided at the time of surgery and could play a role in improving survival and recurrence rates of patients who undergo pancreatectomy. Given that the interactions of the host immune system and cancer microenvironment play an important role in determining outcome, and the fact that transfusion lowers a patient’s immunity and aggravates outcome [8,9], we concluded that intraoperative transfusion (IOT) might lead to poor outcome
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