Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy.
BACKGROUND
The aim of the present study was to investigate the prognostic impact of transfusion following distal pancreatectomy (DP) for left-sided pancreatic ductal adenocarcinoma (PDAC).


METHODS
Retrospective analysis was performed to identify prognostic factors in patients who underwent DP from July 1992 to October 2012.


RESULTS
Forty-eight patients were male, and 35 were female with a mean age of 62 ± 9 years. Twenty-three (27.7%) of the patients received intraoperative blood transfusion. In univariate analysis, combined organ resection (P = 0.046), intraoperative transfusion (P < 0.001), pathologic tumor size (≥3 cm, P = 0.051), clinical tumor size (≥3 cm, P = 0.008), lymph node metastasis (P = 0.021), lymph node ratio (LNR ≥ 0.017, P < 0.001), and tumor differentiation (P = 0.013) were analyzed to predict tumor recurrence. Multivariate analysis showed that lymph node metastasis (Exp(β) = 2.136, P = 0.016), LNR (Exp(β) = 2.003, P = 0.049), and intraoperative transfusion (Exp(β) = 2.793, P = 0.001) were independent prognostic factor predicting tumor recurrence. The amount of estimated blood loss was closely associated with intraoperative transfusion (P < 0.001).


CONCLUSIONS
Intraoperative transfusion should be avoided by gentle operative handling to minimize intraoperative bleeding, and the appropriate transfusion policy should be followed to increase the survival outcome.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Ho Kyoung
HK
Hwang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Myung Jae
MJ
Jung
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Sung Hwan
SH
Lee
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea. cmkang@yuhs.ac.
Chang Moo
CM
Kang
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Korea.
Woo Jung
WJ
Lee
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001803:Blood Transfusion / Q000379:methods / Q000592:standards; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006291:Health Policy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020380:Needs Assessment; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome
Pancreatectomy; Pancreatic cancer; Survival; Transfusion