title: Impact of intraoperative blood transfusion on short and long term outcomes after curative hepatectomy for intrahepatic cholangiocarcinoma: a propensity score matching analysis by the AFC-IHCC study group.
abstract: The impact of intraoperative blood transfusion (IBT) on outcomes following intrahepatic cholangiocarcinoma (IHCC) resection remains to be ascertained.
  
  
  
  All consecutive IHCC resected were analyzed. A first cohort (n = 569) was used for investigating short-term outcomes (morbidity and mortality). A second cohort (n = 522) excluding patients dead within 90 days of surgery was analyzed for exploring overall survival (OS) and disease free survival (DFS). Patients who received IBT were compared to those who did not, after using a propensity score matching (PSM) method.
  
  
  
  Among 569 patients, 90-day morbidity and mortality rates were 47% (n = 269) and 8% (n = 47). After PSM, 208 patients were matched. There was an association between IBT and increased overall morbidity and severe morbidity (p = 0.010). However, IBT did not impact 90-day mortality rate (p > 0.999). Regarding long-term outcomes analysis in the second cohort (n = 522), 5-year OS and DFS rates were 39% and 25%. Using PSM, 196 patients were matched and no association between IBT and OS or DFS was found (p = 0.333 and p = 0.491).
  
  
  
  IBT is associated with an increased risk of morbidity but does not impact on long-term outcomes. Need for IBT should be considered as a surrogate of advanced disease requiring complex resection. Still, restricted transfusion policy should remain advocated for IHCC resection.
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France.
authors.forename: Concepción
authors.initials: C
authors.lastname: Gómez-Gavara
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Doussot
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France.
authors.forename: David
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Hepatobiliary Surgery, AP-HP, Hôpital Beaujon, Clichy, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Farges
authors.affiliation: Department of Surgery, CHU Amiens, Amiens, France.
authors.forename: Jean Marc
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of Hepatobiliary Surgery and Liver Transplantation, AP-HP Hôpital Henri Mondor, Créteil, France; INSERM, U955, Créteil, France. Electronic address: daniel.azoulay@hmn.aphp.fr.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000379:methods; D016009:Chi-Square Distribution; D018281:Cholangiocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D005602:France; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D065227:Transfusion Reaction; D016896:Treatment Outcome