title: 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.
  
  
  BACKGROUND
  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.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Kooby
authors.forename: Jennifer
authors.initials: J
authors.lastname: Stockman
authors.forename: Leah
authors.initials: L
authors.lastname: Ben-Porat
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
authors.forename: Scott
authors.initials: S
authors.lastname: Tuorto
authors.forename: David
authors.initials: D
authors.lastname: Wuest
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D001803:Blood Transfusion; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007902:Length of Stay; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome