title: Peri-operative blood transfusion in gastric cancer surgery: prognostic or confounding factor?
abstract: OBJECTIVE
  The relationship between peri-operative blood transfusions (PBTs) and poor prognosis in gastric cancer (GC) patients is still debated. The aim of this study is to examine the real prognostic impact of PBTs in comparison to well-known prognostic factors.
  
  
  METHODS
  We retrospectively analyzed a series of 224 patients who underwent surgery with curative intent for GC from January 1995 to December 2011. Among 224 patients, 46 (20%) required PBTs.
  
  
  RESULTS
  The overall 5-year survival was 77% in non-transfused patients and 65% in patients who received PBTs (p = 0.03). PBTs did not further stratify any recognized prognostic category (such as pT or pN according to the 7th edition of the TNM staging system). Multivariate analysis including all known prognostic variables (both cancer- and non-cancer-related) did not select PBTs as an independent prognostic factor. Only preoperative hemoglobin and albumin level, pT and operative time were significantly associated with the requirement for PBTs.
  
  
  CONCLUSIONS
  The study showed a worse prognosis for transfused patients, but PBTs seem a confounding factor more than a prognostic indicator, as they are obviously affected by other variables.
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rausei
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ruspi
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Galli
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Tirotta
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Inversini
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Frattini
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Chiappa
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovera
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Boni
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Gianlorenzo
authors.initials: G
authors.lastname: Dionigi
authors.affiliation: Department of General Surgery, University of Insubria, Varese, Italy.
authors.forename: Renzo
authors.initials: R
authors.lastname: Dionigi
mesh_terms: D000368:Aged; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016019:Survival Analysis; D065227:Transfusion Reaction
keywords: Gastric cancer; Peri-operative blood transfusion; Survival