Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis.
OBJECTIVE
To determine the effect of allogeneic blood transfusion (ABT) on clinical outcomes in patients with colorectal cancer undergoing surgery.


BACKGROUND
Perioperative ABTs may be associated with adverse clinical outcomes.


METHODS
Systematic review of the literature with odds ratio (OR) and incidence rate ratio (IRR) meta-analyses of predefined clinical outcomes based on a MEDLINE search.


RESULTS
In total, 20,795 colorectal cancer (CRC) patients observed for more than 59.2 ± 26.1 months (108,838 patient years) were included, of which 58.8% were transfused. ABT was associated with increased all-cause mortality OR = 1.72 (95% confidence interval [CI] 1.55-1.91, P < 0.001); I(2) = 23.3% (0-51.1) and IRR = 1.31 (1.23-1.39, P < 0.001), I(2) = 0.0% (0-37.0). ABT was also associated with increased ORs (95% CI, P) for cancer-related mortality of 1.71 (1.43-2.05, P <0.001), combined recurrence-metastasis-death 1.66 (1.41-1.97, P < 0.001), postoperative infection 3.27 (2.05-5.20, P < 0.001), and surgical reintervention 4.08 (2.18-7.62, <0.001). IRR (95% CI, P) was 1.45 (1.26-1.66, <0.001) for cancer-related mortality and 1.32 (1.19-1.46, <0.001) for recurrence-metastasis-death. Mean length of hospital stay was significantly longer in transfused compared with nontransfused patients (17.8 ± 4.8 vs 13.9 ± 4.7 days, P = 0.005).


CONCLUSIONS
In patients with colorectal cancer (CRC) undergoing surgery, ABTs are associated with adverse clinical outcomes, including increased mortality. Measures aimed at limiting the use of ABTs should be investigated further.
Division of Gastrointestinal Surgery, Nottingham Digestive Disease Centre NIHR, Biomedical Research Unit, Queen's Medical Centre, Nottingham, United Kingdom. austin.acheson@nottingham.ac.uk
Austin G
AG
Acheson
Matthew J
MJ
Brookes
Donat R
DR
Spahn
D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D017707:Erythrocyte Transfusion; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D011379:Prognosis; D016896:Treatment Outcome