Top

Published in:

01-03-2019 | Original Scientific Report (including Papers Presented at Surgical Conferences)

Intraoperative Blood Loss is Associated with Shortened Postoperative Survival of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-institutional Dataset

Authors: Yuki Ito, Mitsuro Kanda, Seiji Ito, Yoshinari Mochizuki, Hitoshi Teramoto, Kiyoshi Ishigure, Toshifumi Murai, Takahiro Asada, Akiharu Ishiyama, Hidenobu Matsushita, Chie Tanaka, Daisuke Kobayashi, Michitaka Fujiwara, Kenta Murotani, Yasuhiro Kodera

Published in: World Journal of Surgery | Issue 3/2019

Abstract

Background

The influence of intraoperative blood loss (IBL) on postoperative long-term outcomes of patients with gastric cancer is controversial. Here, we used a large multicenter dataset from nine institutes to evaluate the prognostic impact of IBL on patients with stage II/III gastric cancer.

Methods

The study analyzed 1013 patients with stage II/III gastric cancer who underwent gastrectomy without preoperative treatment and intraoperative transfusion. Patients were equally divided into learning and validation cohorts using a table of random numbers. The optimal cutoff value of IBL to predict recurrence was determined using the learning cohort, and the prognostic significance of the proposed cutoff was validated using the second cohort.

Results

The optimal cutoff value of IBL determined with the learning cohort using the receiver operating characteristic curve analysis was 330 ml. In the validation cohort, IBL > 330 ml was significantly associated with high body mass index, total gastrectomy, and postoperative complications, but not disease stage and the frequency of adjuvant chemotherapy. The disease-free and disease-specific survival rates of patients in the IBL > 330 ml (IBL-high) group were significantly shorter compared with those in the IBL ≤ 330 ml group. IBL-high was identified as an independent prognostic factor of disease recurrence (hazard ratio 1.45, 95% confidence interval 1.01–2.09, P = 0.0420). The hazard ratio of the IBL-high group was greater in the surgery-alone subgroup compared with that of the postoperative adjuvant-chemotherapy subgroup.

Conclusions

Our analysis of a multicenter dataset indicates that IBL adversely influenced long-term outcomes of patients with stage II/III gastric cancer.

Van Cutsem E, Sagaert X, Topal B et al (2016) Gastric cancer. Lancet 388:2654–2664CrossRefPubMed

Ferlay J, Soerjomataram I, Dikshit R et al (2015) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–E386CrossRef

Shen L, Shan YS, Hu HM et al (2013) Management of gastric cancer in Asia: resource-stratified guidelines. Lancet Oncol 14:e535–e547CrossRefPubMed

Kanda M, Tanaka C, Kobayashi D et al (2017) Proposal of the Coagulation Score as a predictor for short-term and long-term outcomes of patients with resectable gastric cancer. Ann Surg Oncol 24:502–509CrossRefPubMed

Shum H, Rajdev L (2014) Multimodality management of resectable gastric cancer: a review. World J Gastrointest Oncol 6:393–402CrossRefPubMedPubMedCentral

Nagai S, Fujii T, Kodera Y et al (2011) Impact of operative blood loss on survival in invasive ductal adenocarcinoma of the pancreas. Pancreas 40:3–9CrossRefPubMed

Kamei T, Kitayama J, Yamashita H et al (2009) Intraoperative blood loss is a critical risk factor for peritoneal recurrence after curative resection of advanced gastric cancer. World J Surg 33:1240–1246. https://doi.org/10.1007/s00268-009-9979-4 CrossRefPubMed

Morner ME, Gunnarsson U, Jestin P et al (2012) The importance of blood loss during colon cancer surgery for long-term survival: an epidemiological study based on a population based register. Ann Surg 255:1126–1128CrossRefPubMed

Mizuno A, Kanda M, Kobayashi D et al (2016) Adverse effects of intraoperative blood loss on long-term outcomes after curative gastrectomy of patients with stage II/III gastric cancer. Dig Surg 33:121–128CrossRefPubMed

10.

Japanese Gastric Cancer Association (2017) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19CrossRef

11.

Liu JY, Peng CW, Yang XJ et al (2018) The prognosis role of AJCC/UICC 8(th) edition staging system in gastric cancer, a retrospective analysis. Am J Transl Res 10:292–303PubMedPubMedCentral

12.

Kanda M, Kobayashi D, Tanaka C et al (2016) Adverse prognostic impact of perioperative allogeneic transfusion on patients with stage II/III gastric cancer. Gastric Cancer 19:255–263CrossRefPubMed

13.

Kanda M, Tanaka C, Kobayashi D et al (2018) Preoperative albumin–bilirubin grade predicts recurrences after radical gastrectomy in patients with pT2-4 gastric cancer. World J Surg 42:773–781. https://doi.org/10.1007/s00268-017-4234-x CrossRefPubMed

14.

Kanda M, Kodera Y, Sakamoto J (2015) Updated evidence on adjuvant treatments for gastric cancer. Expert Rev Gastroenterol Hepatol 9:1549–1560CrossRefPubMed

15.

Sasako M, Sakuramoto S, Katai H et al (2011) Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 29:4387–4393CrossRef

16.

Kanda M, Murotani K, Kobayashi D et al (2015) Postoperative adjuvant chemotherapy with S-1 alters recurrence patterns and prognostic factors among patients with stage II/III gastric cancer: a propensity score matching analysis. Surgery 158:1573–1580CrossRefPubMed

17.

Miki Y, Tokunaga M, Tanizawa Y et al (2014) Perioperative risk assessment for gastrectomy by surgical apgar score. Ann Surg Oncol 21:2601–2607CrossRefPubMed

18.

Squires MH III, Kooby DA, Poultsides GA et al (2015) 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 221:767–777CrossRefPubMed

19.

Pacelli F, Rosa F, Marrelli D et al (2011) Do perioperative blood transfusions influence prognosis of gastric cancer patients? Analysis of 927 patients and interactions with splenectomy. Ann Surg Oncol 18:1615–1623CrossRefPubMed

20.

Yamashita K, Sakuramoto S, Kikuchi S et al (2007) Transfusion alert for patients with curable cancer. World J Surg 31:2315–2322. https://doi.org/10.1007/s00268-007-9237-6 CrossRefPubMed

21.

Baumgartner JM, Silliman CC, Moore EE et al (2009) Stored red blood cell transfusion induces regulatory T cells. J Am Coll Surg 208:110–119CrossRefPubMed

22.

Zhou HY, Yi W, Wang J et al (2014) Association of perioperative allogeneic blood transfusions and prognosis of patients with gastric cancer after curative gastrectomy. Am J Surg 208:80-87CrossRefPubMed

23.

Dhar DK, Kubota H, Tachibana M et al (2000) Long-term survival of transmural advanced gastric carcinoma following curative resection: multivariate analysis of prognostic factors. World J Surg 24:588–593. https://doi.org/10.1007/s002689910099 discussion 93–4 CrossRefPubMed

24.

Hyung WJ, Noh SH, Shin DW et al (2002) Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Ann Surg Oncol 9:5–12CrossRefPubMed

25.

Bruns CJ, Schafer H, Wolfgarten B et al (1996) Effect of intraoperative blood loss on the function of natural killer cells in tumors of the upper gastrointestinal tract. Langenbecks Arch Chir Suppl Kongressbd 113:146–149PubMed

Title: Intraoperative Blood Loss is Associated with Shortened Postoperative Survival of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-institutional Dataset
Authors: Yuki Ito
Mitsuro Kanda
Seiji Ito
Yoshinari Mochizuki
Hitoshi Teramoto
Kiyoshi Ishigure
Toshifumi Murai
Takahiro Asada
Akiharu Ishiyama
Hidenobu Matsushita
Chie Tanaka
Daisuke Kobayashi
Michitaka Fujiwara
Kenta Murotani
Yasuhiro Kodera
Publication date: 01-03-2019
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 3/2019
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-018-4834-0

At a glance: The STEP trials

Springer Medicine

Intraoperative Blood Loss is Associated with Shortened Postoperative Survival of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-institutional Dataset

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2019

Microdialysis in Postoperative Monitoring of Gastrointestinal Organ Viability: A Systematic Review

Complications After Ostomy Surgery: Emergencies and Obese Patients are at Risk—Data from the Berlin OStomy Study (BOSS)

Soluble Urokinase Plasminogen Activator Receptor (suPAR) as an Added Predictor to Existing Preoperative Risk Assessments

Intraoperative Fluid Administration and Surgical Outcomes Following Pancreaticoduodenectomy: External Validation at a Tertiary Referral Center

Occult Contralateral Lateral Lymph Node Metastases in Unilateral N1b Papillary Thyroid Carcinoma

Propensity-Matched Analysis Comparing Survival After Hybrid Thoracoscopic–Laparotomy Esophagectomy and Complete Thoracoscopic–Laparoscopic Esophagectomy