Degree of blood loss during surgery for rectal cancer: a population-based epidemiologic study of surgical complications and survival.
OBJECTIVE
The hypothesis tested in this study was that major blood loss during surgery for rectal cancer increases the risk for surgical complications and for small bowel obstruction (SBO) as a result of adhesions or tumour recurrence, and reduces overall survival.


METHODS
Data were retrieved from the Uppsala/Örebro Regional Rectal Cancer Registry for all patients undergoing radical resection for rectal cancer during 1997-2003 (n = 1843) and were matched against the Swedish National Patient Registry regarding surgery and admission for SBO. These patient records were scrutinized to determine the etiology of surgery for SBO. The registry was scrutinized for blood loss and other surgical complications associated with surgery. Uni- and multivariate Cox analysis and logistic regression were used.


RESULTS
Ninety-four (5.1%) patients underwent surgery for SBO > 30 days after the index operation: 82 for adhesions and 12 for tumour recurrence. The volume of blood lost did not influence the risk of surgery for SBO as a result of adhesions, but blood loss above the median (≥ 800 ml) increased the risk for surgery for SBO caused by tumour recurrence (hazard ratio = 10.52; 95% CI: 1.36-81.51). Increased blood loss increased the risk of surgical complications (OR = 1.78; 95% CI: 1.35-2.35 with blood loss of ≥ 450 ml) but did not reduce overall survival. Irradiation before surgery increased blood loss, complications and admission for SBO.


CONCLUSIONS
Major blood loss during surgery for rectal cancer increases the risk of later surgery for SBO caused by tumour recurrence and surgical complications, but overall survival is not affected.
Division of Surgery, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden.
M
M
Egenvall
M
M
Mörner
L
L
Påhlman
U
U
Gunnarsson
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D012004:Rectal Neoplasms / Q000401:mortality / Q000601:surgery*; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis; D000267:Tissue Adhesions / Q000453:epidemiology / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome
Rectal cancer; blood loss; complications; small bowel obstruction; surgery; survival