title: Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma.
abstract: BACKGROUND
  Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival.
  
  
  METHODS
  Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed.
  
  
  RESULTS
  Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (P<0.05). In multivariate analysis, only perioperative blood transfusion was independently associated with recurrence (hazard ratio (HR)=2.839 (95 % confidence interval (CI), 1.370-5.884), P=0.005), while perioperative blood transfusion (HR=3.383 (95 % CI, 1.499-7.637), P=0.003) and R1 resection (HR=3.125 (95 % CI, 1.025-9.530), P=0.045) were independent risk factors for poor survival.
  
  
  CONCLUSIONS
  Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.
authors.affiliation: Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori Province, 036-8562, Japan, norihisa@cc.hirosaki-u.ac.jp.
authors.forename: Norihisa
authors.initials: N
authors.lastname: Kimura
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Toyoki
authors.forename: Keinosuke
authors.initials: K
authors.lastname: Ishido
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kudo
authors.forename: Yuta
authors.initials: Y
authors.lastname: Yakoshi
authors.forename: Shinji
authors.initials: S
authors.lastname: Tsutsumi
authors.forename: Takuya
authors.initials: T
authors.lastname: Miura
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Kenichi
authors.initials: K
authors.lastname: Hakamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D001653:Bile Ducts, Intrahepatic / Q000601:surgery*; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D018285:Klatskin Tumor / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends