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Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left‐sided pancreatic cancer: the need for strict transfusion policy
Author(s) -
Hwang Ho Kyoung,
Jung Myung Jae,
Lee Sung Hwan,
Kang Chang Moo,
Lee Woo Jung
Publication year - 2016
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.368
Subject(s) - medicine , blood transfusion , lymph node , pancreatectomy , univariate analysis , distal pancreatectomy , pancreatic cancer , surgery , lymph , dissection (medical) , blood loss , adenocarcinoma , lymph node metastasis , multivariate analysis , metastasis , cancer , resection , pathology
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). Conclusion 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.