title: Perioperative allogenic blood transfusions and the risk of endometrial cancer recurrence.
abstract: OBJECTIVE
  To evaluate the effect of perioperative blood transfusions on the risk of recurrence of endometrial cancer.
  
  
  METHODS
  This study is a retrospective analysis of 358 consecutive patients, without a history of other tumors, who underwent surgery for endometrial cancer between January 2000 and April 2010.
  
  
  RESULTS
  Women who did not need any transfusion (N = 331) and patients who received allogenic blood donations (N = 27) were compared in terms of risk of cancer recurrence. The surgical standard procedure included peritoneal washing for cytologic examination, total hysterectomy + bilateral adnexectomy (N = 358), and pelvic lymphadenectomy (N = 227). The two groups were homogeneous in term of age, BMI, previous abdominal surgery, type of intervention, operative time, nodal count, and hospital stay. The median (range) estimated blood loss was higher in the transfusion group, 400 mL (100-2,000 mL), than in the non-transfusion group, 150 mL (10-1,000 mL). Median (range) follow-up was 67.5 months (6-132.4 months). Blood transfusions were associated with a higher relapse rate (P = 0.0021). At multivariate analysis, administration of packed red blood cells remained independently associated with recurrence (OR 4.64; CI 95 % 1.45-14.9), as well as myometrial invasion ≥50 % (OR 2.88; CI 95 % 1.18-7.07) and stage >1 (OR 4.24; CI 95 % 1.75-10.3).
  
  
  CONCLUSIONS
  The use of allogenic blood transfusions is associated with a higher risk of recurrence. We hypothesize that this could be due to a transitory perioperative immunodepression that promotes the spread of neoplastic cells.
authors.affiliation: Departments of Obstetrics and Gynecology, University of Insubria, Piazza Biroldi, 1, 21100, Varese, Italy. stefucc@libero.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Uccella
authors.forename: Fabio
authors.initials: F
authors.lastname: Ghezzi
authors.forename: Antonella
authors.initials: A
authors.lastname: Cromi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Formenti
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Donadello
authors.forename: Maurizio
authors.initials: M
authors.lastname: Serati
authors.forename: Pierfrancesco
authors.initials: P
authors.lastname: Bolis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000601:surgery*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D007239:Infections / Q000453:epidemiology; D010535:Laparoscopy; D008197:Lymph Node Excision; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010388:Pelvis; D019990:Perioperative Care; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors