title: Impact of intraoperative blood loss on survival after curative resection for gastric cancer.
abstract: OBJECTIVE
  To elucidate the potential impact of intraoperative blood loss (IBL) on long-term survival of gastric cancer patients after curative surgery.
  
  
  METHODS
  A total of 845 stage I-III gastric cancer patients who underwent curative gastrectomy between January 2003 and December 2007 in our center were enrolled in this study. Patients were divided into 3 groups according to the amount of IBL: group 1 (< 200 mL), group 2 (200-400 mL) and group 3 (> 400 mL). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The Log-rank test was used to assess statistical differences between the groups. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of IBL on survival in each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. Finally, we explored the possible factors associated with IBL and identified the independent risk factors for IBL ≥ 200 mL.
  
  
  RESULTS
  Overall survival was significantly influenced by the amount of IBL. The 5-year overall survival rates were 51.2%, 39.4% and 23.4% for IBL less than 200 mL, 200 to 400 mL and more than 400 mL, respectively (< 200 mL vs 200-400 mL, P < 0.001; 200-400 mL vs > 400 mL, P = 0.003). Age, tumor size, Borrmann type, extranodal metastasis, tumour-node-metastasis (TNM) stage, chemotherapy, extent of lymphadenectomy, IBL and postoperative complications were found to be independent prognostic factors in multivariable analysis. Following stratified analysis, patients staged TNM I-II and those with IBL less than 200 mL tended to have better survival than those with IBL not less than 200 mL, while patients staged TNM III, whose IBL was less than 400 mL had better survival. Tumor location, tumor size, TNM stage, type of gastrectomy, combined organ resection, extent of lymphadenectomy and year of surgery were found to be factors associated with the amount of IBL, while tumor location, type of gastrectomy, combined organ resection and year of surgery were independently associated with IBL ≥ 200 mL.
  
  
  CONCLUSIONS
  IBL is an independent prognostic factor for gastric cancer after curative resection. Reducing IBL can improve the long-term outcome of gastric cancer patients following curative gastrectomy.
authors.affiliation: Yue-Xiang Liang, Jing-Yu Deng, Bao-Gui Wang, Xue-Wei Ding, Xiao-Na Wang, Li Zhang, Han Liang, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
authors.forename: Yue-Xiang
authors.initials: YX
authors.lastname: Liang
authors.forename: Han-Han
authors.initials: HH
authors.lastname: Guo
authors.forename: Jing-Yu
authors.initials: JY
authors.lastname: Deng
authors.forename: Bao-Gui
authors.initials: BG
authors.lastname: Wang
authors.forename: Xue-Wei
authors.initials: XW
authors.lastname: Ding
authors.forename: Xiao-Na
authors.initials: XN
authors.lastname: Wang
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.forename: Han
authors.initials: H
authors.lastname: Liang
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality*; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D012307:Risk Factors; D013270:Stomach / Q000473:pathology; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*
keywords: Blood transfusion; Gastric carcinoma; Intraoperative blood loss; Postoperative complication; Prognosis
references.citation: Langenbecks Arch Surg. 2009 Jan;394(1):41-7
references.pmid: 18584204
references.citation: World J Surg. 2009 Jun;33(6):1240-6
references.pmid: 19308640
references.citation: J Urol. 1995 Aug;154(2 Pt 1):442-7
references.pmid: 7609106
references.citation: Br J Surg. 2003 Oct;90(10):1261-6
references.pmid: 14515297
references.citation: J Surg Oncol. 1994 Mar;55(3):149-53
references.pmid: 8176923
references.citation: Arch Surg. 1999 Dec;134(12):1325-31; discussion 1331-2
references.pmid: 10593330
references.citation: N Engl J Med. 2008 Jul 31;359(5):453-62
references.pmid: 18669424
references.citation: Br J Surg. 2000 Mar;87(3):353-7
references.pmid: 10718807
references.citation: Langenbecks Arch Chir Suppl Kongressbd. 1996;113:146-9
references.pmid: 9101816
references.citation: Dig Dis Sci. 2000 Sep;45(9):1737-42
references.pmid: 11052313
references.citation: Am J Surg. 1994 Feb;167(2):256-60
references.pmid: 8135315
references.citation: Cancer. 1990 Dec 1;66(11):2331-5
references.pmid: 2245388
references.citation: J Am Coll Surg. 2004 Jan;198(1):42-50
references.pmid: 14698310
references.citation: Lancet Oncol. 2010 May;11(5):439-49
references.pmid: 20409751
references.citation: Dig Dis Sci. 1997 Oct;42(10):2072-6
references.pmid: 9365137
references.citation: Clin Oncol (R Coll Radiol). 2006 Feb;18(1):60-6
references.pmid: 16477921
references.citation: Surg Innov. 2005 Dec;12(4):339-44
references.pmid: 16424955
references.citation: Pancreas. 2011 Jan;40(1):3-9
references.pmid: 20881897
references.citation: Gastric Cancer. 2011 Oct;14(4):301-16
references.pmid: 21894577
references.citation: J Gastrointest Surg. 2009 Oct;13(10):1821-30
references.pmid: 19655208
references.citation: Fertil Steril. 2010 Oct;94(5):1882-6
references.pmid: 19819439
references.citation: Cancer. 1996 Jun 15;77(12):2445-8
references.pmid: 8640691
references.citation: Ann Surg. 2005 Jan;241(1):27-39
references.pmid: 15621988
references.citation: Eur J Immunol. 2004 Aug;34(8):2129-37
references.pmid: 15259010
references.citation: Ann Surg Oncol. 2002 Jan-Feb;9(1):5-12
references.pmid: 11829431
references.citation: Suppl Tumori. 2003 Sep-Oct;2(5):S27-30
references.pmid: 12914386
references.citation: Gastric Cancer. 2006;9(2):51-66
references.pmid: 16767357
references.citation: Ann Surg. 2012 Jun;255(6):1126-8
references.pmid: 22498893
references.citation: World J Surg. 2000 May;24(5):588-93; discussion 593-4
references.pmid: 10787082
references.citation: Surg Today. 1998;28(6):576-9
references.pmid: 9681604
references.citation: J Am Acad Psychoanal. 1990 Winter;18(4):654-66
references.pmid: 2283344
references.citation: Br J Surg. 2010 Jul;97(7):1035-42
references.pmid: 20632269
references.citation: World J Surg. 1989 Sep-Oct;13(5):637-43
references.pmid: 2683404
references.citation: Dis Colon Rectum. 2005 May;48(5):1021-6
references.pmid: 15789125
references.citation: Oncology. 1995 Mar-Apr;52(2):170-5
references.pmid: 7854780
references.citation: Transfusion. 1987 Sep-Oct;27(5):375-7
references.pmid: 3629666
references.citation: Cancer. 2000 Jul 15;89(2):255-61
references.pmid: 10918153
references.citation: Ann Surg Oncol. 2013 May;20(5):1575-83
references.pmid: 23076557