title: Correlations between neoadjuvant treatment, anemia, and perioperative complications in patients undergoing esophagectomy for cancer.
abstract: BACKGROUND
  The influence of preoperative hemoglobin levels on outcomes of patients undergoing esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative anemia status, and perioperative blood transfusion and risk of postoperative complications among patients undergoing esophageal resection.
  
  
  METHODS
  From a retrospective esophageal database, 413 patients were identified. Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively. Statistical analysis was performed with analysis of variance, Pearson's chi(2), or Fisher exact test as appropriate. The independent association of anemia, blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple logistic regression.
  
  
  RESULTS
  Information on combined modality treatment, preoperative hemoglobin levels, and blood transfusion was available for 413 patients, of whom 57% received combined modality treatment. Overall 197 (47.6%) patients were preoperatively found to be anemic, and those who had received combined modality treatment were more likely to be anemic (60.6% versus 30.7%, P < 0.001). Anemic patients required more blood transfusions than nonanemic patients (46.7% versus 29.6%, P < 0.001). Seventy-five percent of patients who required transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and anemia were not associated with increased risk of complications. Patients with any perioperative complication and surgical site infections were more likely to have received blood transfusion compared to patients without complications (OR = 1.73; 95% CI 1.04-2.87 and OR = 2.98; 95% CI 1.04-8.55; respectively).
  
  
  CONCLUSIONS
  Overall, we determined that administration of neoadjuvant treatment to esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative anemia did not predict worsened short-term outcomes, but increased the chances of red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of surgical site infections. These data confirm previous studies that allogenic red blood cell transfusions are independent risk factors for increased morbidity and mortality and should be minimized during surgery for esophageal cancer.
authors.affiliation: Division of Gastrointestinal Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, USA. marcovalerio.melis@moffitt.org
authors.forename: Marcovalerio
authors.initials: M
authors.lastname: Melis
authors.forename: James M
authors.initials: JM
authors.lastname: McLoughlin
authors.forename: E Michelle
authors.initials: EM
authors.lastname: Dean
authors.forename: Erin M
authors.initials: EM
authors.lastname: Siegel
authors.forename: Jill M
authors.initials: JM
authors.lastname: Weber
authors.forename: Nilay
authors.initials: N
authors.lastname: Shah
authors.forename: Scott T
authors.initials: ST
authors.lastname: Kelley
authors.forename: Richard C
authors.initials: RC
authors.lastname: Karl
mesh_terms: D000368:Aged; D000740:Anemia / Q000150:complications / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006454:Hemoglobins; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology; D065227:Transfusion Reaction
chemical_list: D006454:Hemoglobins