Blood loss and transfusion after total mesorectal excision and conventional rectal cancer surgery.
OBJECTIVE
A recent study showed less bleeding and need of transfusion after total mesorectal excision (TME) compared with conventional rectal cancer surgery. The aim of this study was to evaluate this result in more details.


METHODS
Comparison of transfusion history in rectal cancer resections in two different multicentre-studies. Two hundred and forty-six patients were operated in the period 1991-93 with a conventional technique and 311 patients were operated with TME-technique in the period 1996-98. Peri-operative data, including blood transfusion from one month before until one month after the operation, was recorded prospectively.


RESULTS
The median intra-operative blood loss was 1000 ml, range 50-6000 ml, before, and 550 ml, range 10-6000 ml (P < 0.001) after introduction of TME. The overall peri-operative transfusion rate was reduced from 73% to 43% (P < 0.001). When adjusted for blood loss, age, gender, weight, and type of resection, TME significantly reduced the risk of receiving intra or postoperative blood transfusion by 0.4 (CI: 0.3-0.6). The variability in blood loss among 12 TME-centres was more than 400% and not correlated with transfusion requirements within the centres.


CONCLUSIONS
TME results in a reduced blood loss and a reduction of blood transfusion, but additional factors others than blood loss seems to influence the decision of transfusion.
Mynster
T
T
Department of Surgical Gastroenterology K, H:S Bispebjerg Hospital, Copenhagen University, 2400-NV Copenhagen, Denmark.
Nielsen
H J
HJ
Harling
H
H
Bülow
S
S
D000368:Aged; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000379:methods*; D003107:Colorectal Surgery / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology*; D009367:Neoplasm Staging; D011300:Preoperative Care; D011336:Probability; D011351:Proctoscopy; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012016:Reference Values; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome