title: Intraoperative blood loss is a critical risk factor for peritoneal recurrence after curative resection of advanced gastric cancer.
abstract: BACKGROUND
  Perioperative blood transfusion has been shown to be associated with poor outcome in various types of malignancy. However, the relationship between the amount of blood loss and specific types of cancer recurrence has not been documented.
  
  
  METHODS
  We retrospectively examined the amount of intraoperative blood loss and the recurrence pattern in 146 patients who underwent curative gastrectomy for advanced gastric cancer and assessed the possible correlation between intraoperative blood loss and peritoneal, locoregional, and hematogenous recurrences.
  
  
  RESULTS
  The amount of intraoperative blood loss in patients who developed peritoneal recurrence was significantly greater than that in patients without peritoneal recurrence, irrespective of blood transfusion. In contrast, the blood loss was not associated with nodal or hematogenous recurrence. Multivariate analysis demonstrated that large blood loss as well as operative curability B and adjuvant chemotherapy were independent risk factors for peritoneal recurrence and a worse outcome in advanced gastric cancer.
  
  
  CONCLUSIONS
  Intraoperative blood loss in curative gastrectomy for advanced gastric cancer may have a specific association with the development of peritoneal recurrence. Surgeons must remember that clean and dry surgery may lessen not only 30-day mortality and morbidity but long-term peritoneal recurrence in gastric cancer.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. KAMEIT-SUR@h.u-tokyo.ac.jp
authors.forename: Takao
authors.initials: T
authors.lastname: Kamei
authors.forename: Joji
authors.initials: J
authors.lastname: Kitayama
authors.forename: Hiroharu
authors.initials: H
authors.lastname: Yamashita
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Nagawa
mesh_terms: D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D002277:Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008137:Longitudinal Studies; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D010534:Peritoneal Neoplasms / Q000556:secondary*; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D065227:Transfusion Reaction; D016896:Treatment Outcome