title: Impact of operative blood loss on survival in invasive ductal adenocarcinoma of the pancreas.
abstract: OBJECTIVE
  The aim of this study was to determine the prognostic factors and assess the impact of excessive operative blood loss (OBL) on survival after pancreatectomy for invasive ductal adenocarcinoma.
  
  
  METHODS
  From the retrospective analysis, 271 patients were eligible for evaluation. Overall survival was assessed to clarify the prognostic determinants, including patient characteristics, perioperative factors, and tumor characteristics.
  
  
  RESULTS
  The overall survival was significantly affected by the amount of OBL. The median survival times were 26.0, 15.3, and 8.7 months for OBL less than 1000, 1000 to 2000, and greater than 2000 mL, respectively (<1000 vs 1000-2000 mL, P=0.019; 1000-2000 vs >2000 mL, P<0.0001). Operative blood loss greater than 2000 mL remained an independent prognostic factor in multivariate analysis (P=0.003; hazards ratio, 2.55). Operative blood loss of 2010 mL was found to be an appropriate cutoff level to predict early mortality within 6 months after resection (sensitivity, 0.660; specificity, 0.739). Male sex, year of resection, and plexus invasion were independently associated with OBL greater than 2000 mL.
  
  
  CONCLUSIONS
  Excessive OBL was found to be a prognostic determinant of survival after surgery for pancreatic cancer. Operative blood loss can be used to stratify the risk for pancreatic cancer mortality. Successful curative resection with limited blood loss can contribute to improved survival.
authors.affiliation: Department of Surgery II, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Nagai
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Fujii
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Mitsuro
authors.initials: M
authors.lastname: Kanda
authors.forename: Tevfik T
authors.initials: TT
authors.lastname: Sahin
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Kanzaki
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamada
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sugimoto
authors.forename: Shuji
authors.initials: S
authors.lastname: Nomoto
authors.forename: Shin
authors.initials: S
authors.lastname: Takeda
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000601:surgery; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000601:surgery; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012307:Risk Factors