Abstract
Background
Whether intraoperative blood loss (IBL) was independently associated with poor prognosis of gastric cancer (GC) patients remains controversial. In the present study, we evaluated the impact of IBL on the disease-free survival (DFS) of GC patients.
Methods
A total of 1669 patients who underwent curative gastrectomy for GC were reviewed retrospectively. All patients were classified as IBL < 400 mL and IBL ≥ 400 mL group according to the amount of IBL. The prognostic difference between two patient groups was compared and clinicopathologic factors associated with the prognosis of GC patients were analyzed.
Results
The 5-year DFS rate of the patients with IBL < 400 mL and those with IBL ≥ 400 mL was 52.1% and 41.5%, respectively (P < 0.001). The 5-year DFS rate of the patients who did and did not receive intraoperative blood transfusion was 36.9% and 53.2%, respectively (P < 0.001). However, the similar survival outcomes were not observed in the subgroup analysis based on the TNM stage. The multivariate analysis indicated that IBL (HR 1.021, 95% CI 0.875–1.191, P > 0.05) and intraoperative blood transfusion (HR 1.111, 95% CI 0.943–1.309, P > 0.05) were not independent prognostic factors for GC patients. In addition, the patients with IBL ≥ 400 mL had a higher risk of postoperative complications than those with IBL < 400 mL, especially for intraabdominal infection and wound infection. The tumor located in upper 1/3 stomach, total gastrectomy, combined organ resection and advanced tumor stage (stage III) were independent risk factors for intraoperative massive hemorrhage.
Conclusion
Intraoperative blood loss was significantly associated with tumor-related and surgery-related factors. Intraoperative blood loss itself could not independently affect survival outcome of GC patients after curative gastrectomy.
Similar content being viewed by others
References
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.
Seevaratnam R, Bocicariu A, Cardoso R, Mahar A, Kiss A, Helyer L, et al. A meta-analysis of D1 versus D2 lymph node dissection. Gastric Cancer. 2012;15(Suppl 1):S60–9.
Mocellin S, McCulloch P, Kazi H, Gama-Rodrigues JJ, Yuan Y, Nitti D. Extent of lymph node dissection for adenocarcinoma of the stomach. Cochrane Database Syst Rev. 2015. https://doi.org/10.1002/14651858.cd001964.pub4.(8):cd001964.
Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.
Japanese Gastric Cancer A. Japanese classification of gastric carcinoma—2nd english edition. Gastric Cancer. 1998;1(1):10–24.
Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.
Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, Fujii T, et al. Adverse prognostic impact of perioperative allogeneic transfusion on patients with stage II/III gastric cancer. Gastric Cancer. 2016;19(1):255–63.
Squires MH 3rd, Kooby DA, Poultsides GA, Weber SM, Bloomston M, Fields RC, et al. Effect of perioperative transfusion on recurrence and survival after gastric cancer resection: a 7-institution analysis of 765 patients from the US Gastric Cancer Collaborative. J Am Coll Surg. 2015;221(3):767–77.
Zhou HY, Yi W, Wang J, Zhang J, Wang WJ, Hu ZQ. Association of perioperative allogeneic blood transfusions and prognosis of patients with gastric cancer after curative gastrectomy. Am J Surg. 2014;208(1):80–7.
Rausei S, Ruspi L, Galli F, Tirotta F, Inversini D, Frattini F, et al. Peri-operative blood transfusion in gastric cancer surgery: prognostic or confounding factor? Int J Surg. 2013;11(Suppl 1):S100–3.
Cui J, Deng J, Ding X, Zhang L, Zhang R, Wu W, et al. Blood transfusion does not affect survival of gastric cancer patients. J Surg Res. 2016;200(1):98–104.
Kamei T, Kitayama J, Yamashita H, Nagawa H. Intraoperative blood loss is a critical risk factor for peritoneal recurrence after curative resection of advanced gastric cancer. World J Surg. 2009;33(6):1240–6.
Arita T, Ichikawa D, Konishi H, Komatsu S, Shiozaki A, Hiramoto H, et al. Increase in peritoneal recurrence induced by intraoperative hemorrhage in gastrectomy. Ann Surg Oncol. 2015;22(3):758–64.
Mizuno A, Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, et al. Adverse Effects of Intraoperative Blood Loss on Long-Term Outcomes after Curative Gastrectomy of Patients with Stage II/III Gastric Cancer. Digest Surg. 2016;33(2):121–8.
Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol. 2010;17(12):3077–9.
Liang YX, Guo HH, Deng JY, Wang BG, Ding XW, Wang XN, et al. Impact of intraoperative blood loss on survival after curative resection for gastric cancer. World J Gastroenterol. 2013;19(33):5542–50.
Ojima T, Iwahashi M, Nakamori M, Nakamura M, Naka T, Katsuda M, et al. Association of allogeneic blood transfusions and long-term survival of patients with gastric cancer after curative gastrectomy. J Gastrointestinal Surg. 2009;13(10):1821–30.
Xiao H, Liu W, Quan H, Ouyang Y. Peri-operative blood transfusion does not influence overall and disease-free survival after radical gastrectomy for stage II/III gastric cancer: a propensity score matching analysis. J Gastrointestinal Surg. 2018;22(9):1489–500.
Warschkow R, Guller U, Koberle D, Muller SA, Steffen T, Thurnheer M, et al. Perioperative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg. 2014;259(1):131–8.
Sugoor P, Shah S, Dusane R, Desouza A, Goel M, Shrikhande SV. Proximal gastrectomy versus total gastrectomy for proximal third gastric cancer: total gastrectomy is not always necessary. Langenbeck’s Arch Surg. 2016;401(5):687–97.
Nozaki I, Hato S, Kobatake T, Ohta K, Kubo Y, Kurita A. Long-term outcome after proximal gastrectomy with jejunal interposition for gastric cancer compared with total gastrectomy. World J Surg. 2013;37(3):558–64.
Ushimaru Y, Fujiwara Y, Shishido Y, Yanagimoto Y, Moon JH, Sugimura K, et al. Clinical outcomes of gastric cancer patients who underwent proximal or total gastrectomy: a propensity score-matched analysis. World J Surg. 2018;42(5):1477–84.
Ohkura Y, Haruta S, Shindoh J, Tanaka T, Ueno M, Udagawa H. Efficacy of prophylactic splenectomy for proximal advanced gastric cancer invading greater curvature. World J Surg Oncol. 2017;15(1):106.
Oh SJ, Hyung WJ, Li C, Song J, Kang W, Rha SY, et al. The effect of spleen-preserving lymphadenectomy on surgical outcomes of locally advanced proximal gastric cancer. J Surg Oncol. 2009;99(5):275–80.
Son SY, Shin DJ, Park YS, Oo AM, Jung DH, Lee CM, et al. Spleen-preserving lymphadenectomy versus splenectomy in laparoscopic total gastrectomy for advanced gastric cancer. Surg Oncol. 2017;26(2):207–11.
Funding
This work was supported by Natural Science Foundation of Liaoning province (no. 20180530026).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This study was approved by the Ethics Committee of China Medical University, and all procedures performed in studies involving human participants were in accordance with the ethical standards published in the 1964 Helsinki Declaration and its later amendments.
Informed consent
All individual participants included in this study were provided with written informed consent.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zhao, B., Huang, X., Lu, H. et al. Intraoperative blood loss does not independently affect the survival outcome of gastric cancer patients who underwent curative resection. Clin Transl Oncol 21, 1197–1206 (2019). https://doi.org/10.1007/s12094-019-02046-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12094-019-02046-6