The Impact of Perioperative Red Blood Cell Transfusions on Long-Term Outcomes after Hepatectomy for Colorectal Liver Metastases.
BACKGROUND
Red blood cell transfusions (RBCTs) are associated with cancer recurrence following resection of colorectal cancer. Their impact after colorectal liver metastases (CRLM) resection remains debated. We sought to explore the association between perioperative RBCT and oncologic outcomes following resection of CRLM.


METHODS
We reviewed patients undergoing partial hepatectomy for CRLM from 2003 to 2012 at a single institution. Date of death was abstracted from a validated population-based cancer registry. Primary outcome was overall survival (OS). Secondary outcome was recurrence-free survival (RFS). Survivals were estimated using Kaplan-Meier methods and compared with log-rank test based on transfusion status. Cox regression analysis examined the association of RBCT with OS and RFS, while adjusting for age, preoperative chemotherapy, Clinical Risk Score, and period of treatment (2003-2007 vs. 2008-2012).


RESULTS
Among 483 patients, 27.5 % received RBCT. Ninety-day postoperative mortality was 4.8 %. At median follow-up of 33 (interquartile range 20.1-54.8) months, 5-year OS was inferior in transfused patients (45.9 vs. 61.0 %; p < 0.0001). Five-year RFS was decreased with RBCT (15.5 vs. 31.6 %; p < 0.0001). The difference persisted when considering only 90-day survivors for 5-year OS (53.1 vs. 61.9 %, p = 0.023) and RFS (15.6 vs. 31.6 %; p < 0.0001). After adjustment for prognostic factors, RBCT was independently associated with decreased OS (hazard ratio 2.24; 95 % confidence interval 1.60-3.15) and RFS (hazard ratio 1.71; 95 % confidence interval 1.28-2.28).


CONCLUSIONS
Perioperative RBCT is independently associated with decreased OS and RFS following hepatectomy for CRLM. Interventions to minimize and rationalize the use of RBCT for hepatectomy are warranted to mitigate this detrimental effect on long-term outcomes.
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada. julie.hallet@sunnybrook.ca.|Department of Surgery, University of Toronto, Toronto, ON, Canada. julie.hallet@sunnybrook.ca.
Julie
J
Hallet
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
Melanie
M
Tsang
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Eva S W
ES
Cheng
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Rogeh
R
Habashi
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.
Iryna
I
Kulyk
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
Sherif S
SS
Hanna
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
Natalie G
NG
Coburn
Division of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.|Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
Yulia
Y
Lin
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
Calvin H L
CH
Law
Division of General Surgery, Sunnybrook Health Sciences Centre - Odette Cancer Centre, Toronto, ON, Canada.|Department of Surgery, University of Toronto, Toronto, ON, Canada.
Paul J
PJ
Karanicolas
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology*; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors