Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 643-654
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.643
Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer
Lucas Eiki Kawakami, Pedro Barzan Bonomi, Marina Alessandra Pereira, Fabrício Oliveira Carvalho, Ulysses Ribeiro Jr, Bruno Zilberstein, Luciana Ribeiro Sampaio, Luiz Augusto Carneiro-D'Albuquerque, Marcus Fernando Kodama Pertille Ramos
Lucas Eiki Kawakami, Pedro Barzan Bonomi, Marina Alessandra Pereira, Ulysses Ribeiro Jr, Bruno Zilberstein, Luiz Augusto Carneiro-D'Albuquerque, Marcus Fernando Kodama Pertille Ramos, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil
Fabrício Oliveira Carvalho, Luciana Ribeiro Sampaio, Blood Transfusion Unit, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil
Author contributions: Kawakami LE and Bonomi PB contributed to data retrieval, critical analysis, and manuscript drafting; Pereira MA contributed to data retrieval, critical analysis, statistical analysis, and manuscript review; Carvalho FO and Sampaio LR contributed to data retrieval and manuscript review; Ribeiro Jr. U, Zilberstein B, and Carneiro-D'Albuquerque LA contributed to critical analysis and manuscript review; Ramos MFKP contributed to study design, data retrieval, critical analysis, and manuscript drafting.
Institutional review board statement: The study was approved by the Hospital Ethics Committee and registered online (https://plataformabrasil.saude.gov.br; CAAE: 59337222.7.0000.0068).
Informed consent statement: Informed consent was waived by the local ethics committee, given the study's retrospective nature.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Marcus Fernando Kodama Pertille Ramos, PhD, Doctor, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 251, Sao Paulo 01249000, Brazil. marcus.kodama@hc.fm.usp.br
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: February 3, 2023
Revised: February 12, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: April 27, 2023
Abstract
BACKGROUND

Gastric cancer (GC) is still a prevalent neoplasm around the world and its main treatment modality is surgical resection. The need for perioperative blood transfusions is frequent, and there is a long-lasting debate regarding its impact on survival.

AIM

To evaluate the factors related to the risk of receiving red blood cell (RBC) transfusion and its influence on surgical and survival outcomes of patients with GC.

METHODS

Patients who underwent curative resection for primary gastric adenocarcinoma at our Institute between 2009 and 2021 were retrospectively evaluated. Clinicopathological and surgical characteristics data were collected. The patients were divided into transfusion and non-transfusion groups for analysis.

RESULTS

A total of 718 patients were included, and 189 (26.3%) patients received perioperative RBC transfusion (23 intraoperatively, 133 postoperatively, and 33 in both periods). Patients in the RBC transfusions group were older (P < 0.001), and had more comorbidities (P = 0.014), American Society of Anesthesiologists classification III/IV (P < 0.001), and lower preoperative hemoglobin (P < 0.001) and albumin levels (P < 0.001). Larger tumors (P < 0.001) and advanced tumor node metastasis stage (P < 0.001) were also associated with the RBC transfusion group. The rates of postoperative complications (POC) and 30-d and 90-d mortality were significantly higher in the RBC transfusion group than in the non-transfusion group. Lower hemoglobin and albumin levels, total gastrectomy, open surgery, and the occurrence of POC were factors associated with the RBC transfusion. Survival analysis demonstrated that the RBC transfusions group had worse disease-free survival (DFS) and overall survival (OS) compared with patients who did not receive transfusion (P < 0.001 for both). In multivariate analysis, RBC transfusion, major POC, pT3/T4 category, pN+, D1 lymphadenectomy, and total gastrectomy were independent risk factors related to worse DFS and OS.

CONCLUSION

Perioperative RBC transfusion is associated with worse clinical conditions and more advanced tumors. Further, it is an independent factor related to worse survival in the curative intent gastrectomy setting.

Keywords: Stomach neoplasms, Blood transfusion, Red blood cells, Postoperative complications, Survival, Prognosis

Core Tip: This is a retrospective study to investigate the association of perioperative red blood cell (RBC) transfusion with surgical and survival outcomes in patients with gastric cancer. Our findings demonstrated that patients who received RBC transfusion had poorer preoperative clinical conditions and more aggressive tumors, and were submitted to more invasive procedures. The rates of postoperative complications and 30-d and 90-d mortality were also significantly higher in patients who received RBC transfusions compared to those who did. Further, receiving an RBC transfusion was an independent factor associated with worse survival.