Researchers from Southampton, England, determined whether blood transfusion influences survival after esophagectomy for carcinoma.
The study group comprised 234 consecutive patients (175 men) with a mean age of 66 years. All underwent esophagectomy for carcinoma by one surgeon between 1988 and 1998.
The impact of 41 variables on survival was determined by means of univariate and multivariate analysis.
The patients were followed up for a mean of 19.2 months.
The operative mortality rate was 6% and median operative blood loss was 700 ml.
A total of 161 patients (69%) received a blood transfusion postoperatively (mean transfusion, 2.6 units).
Overall actuarial 1-year, 3-year, and 5-year survival rates, inclusive of operative mortality, were 58%, 29%, and 16%, respectively.
| Blood transfused should be limited to the absolute essential requirement.
| Annals of Thoracic Surgery |
There were a number of significant negative factors for survival on univariate analysis. These included positive lymph nodes, pathological TNM stage, and transfusion of more than 3 units of blood.
Incomplete resection, poor tumor cell differentiation, longer tumor, greater weight loss, male sex, and adenocarcinoma were also negative factors.
On Cox proportional hazards regression analysis, after excluding operative mortality, independent adverse predictors of late survival included lymph node involvement and incomplete resection. Poor tumor cell differentiation and transfusion of more than 3 units of blood were further adverse predictors.
Stephen M. Langley, of Southampton General Hospital, said on behalf of fellow authors, "In addition to reaffirming the importance of completeness of resection and nodal involvement, this study demonstrates that blood transfusion (more than 3 units) may have a significant adverse effect on late survival after esophageal resection for carcinoma."
"Every effort should be made to limit the amount of transfused blood to the absolutely essential requirements," he concluded.