title: Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis.
abstract: BACKGROUND
  Perioperative blood transfusion (PBT) is common in pancreatic surgery. Recent studies have suggested that PBT may be associated with worse long-term outcomes.
  
  
  METHODS
  A systematic review and meta-analysis of studies comparing long-term clinical outcomes of cancer patients undergoing curative-intent pancreatic surgery with regard to occurrence of PBT was performed.
  
  
  RESULTS
  A total of 23 studies (4339 patients) were included in the systematic review, and 19 studies (3646 patients) were included in the meta-analysis. Nearly half (45.8 %) of all patients were female (range 25-60 %), and median age ranged from 59 to 72 years. About half (46.5 %, range 19-72 %) of the patients were transfused. Most had pancreatic ductal adenocarcinoma (69.5 %), while others had ampullary carcinoma (15.0 %), cholangiocarcinoma (7.4 %), or exocrine tumors of pancreas (8.1 %). Most (91.1 %) underwent pancreaticoduodenectomy, while the remaining patients underwent a total or distal pancreatectomy. The 5-year overall survival for all patients ranged from 0 to 65 %. Thirteen and nine of 19 studies reported a detrimental effect of PBT on survival on univariable and multivariable analysis, respectively. Overall, PBT was associated with shorter overall survival (pooled odds ratio 2.43, 95 % confidence interval 1.90-3.10); this finding was reproduced in sensitivity analysis.
  
  
  CONCLUSIONS
  Patients receiving PBT had significantly lower 5-year survival after curative-intent pancreatic surgery. Further research should focus on implementing guidelines for and discerning factors associated with the poor outcomes after PBT.
authors: Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Alfa Institute of Biomedical Sciences, Marousi, Athens, Greece.
authors: Michael N
authors: MN
authors: Mavros
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.|State Key Laboratory of Oncology in Southern China, Guangzhou, China.
authors: Li
authors: L
authors: Xu
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Hadia
authors: H
authors: Maqsood
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Faiz
authors: F
authors: Gani
authors: Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.
authors: Aslam
authors: A
authors: Ejaz
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Gaya
authors: G
authors: Spolverato
authors: Department of Surgery, MedStar Georgetown University Hospital Center, Washington, DC, USA.
authors: Waddah B
authors: WB
authors: Al-Refaie
authors: Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: Steven M
authors: SM
authors: Frank
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpawlik1@jhmi.edu.
authors: Timothy M
authors: TM
authors: Pawlik
mesh_terms: D001803:Blood Transfusion; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019990:Perioperative Care; D011379:Prognosis; D015996:Survival Rate