Top

World Journal of Surgical Oncology

Published in:

Open Access 01-12-2019 | Colorectal Cancer | Research

Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis

Authors: Qian-Yun Pang, Ran An, Hong-Liang Liu

Published in: World Journal of Surgical Oncology | Issue 1/2019

Abstract

Background

Perioperative transfusion can reduce the survival rate in colorectal cancer patients. The effects of transfusion on the short- and long-term prognoses are becoming intriguing.

Objective

This systematic review and meta-analysis aimed to define the effects of perioperative transfusion on the short- and long-term prognoses of colorectal cancer surgery.

Results

Thirty-six clinical observational studies, with a total of 174,036 patients, were included. Perioperative transfusion decreased overall survival (OS) (hazard ratio (HR), 0.33; 95% confidence interval (CI), 0.24 to 0.41; P < 0.0001) and cancer-specific survival (CSS) (HR, 0.34; 95% CI, 0.21 to 0.47; P < 0.0001), but had no effect on disease-free survival (DFS) (HR, 0.17; 95% CI, − 0.12 to 0.47; P = 0.248). Transfusion could increase postoperative infectious complications (RR, 1.89, 95% CI, 1.56 to 2.28; P < 0.0001), pulmonary complications (RR, 2.01; 95% CI, 1.54 to 2.63; P < 0.0001), cardiac complications (RR, 2.20; 95% CI, 1.75 to 2.76; P < 0.0001), anastomotic complications (RR, 1.51; 95% CI, 1.29 to 1.79; P < 0.0001), reoperation(RR, 2.88; 95% CI, 2.05 to 4.05; P < 0.0001), and general complications (RR, 1.86; 95% CI, 1.66 to 2.07; P < 0.0001).

Conclusion

Perioperative transfusion causes a dramatically negative effect on long-term prognosis and increases short-term complications after colorectal cancer surgery.

Tarantino I, Ukegjini K, Warschkow R, Schmied BM, Steffen T, Ulrich A, et al. Blood transfusion does not adversely affect survival after elective colon cancer resection: a propensity score analysis. Langenbeck's Arch Surg. 2013;398(6):841–9. https://doi.org/10.1007/s00423-013-1098-x PubMed PMID: 23838797.CrossRef

Gunka I, Dostalik J, Martinek L, Gunkova P, Mazur M. Impact of blood transfusions on survival and recurrence in colorectal cancer surgery. Indian J Surg. 2013;75(2):94–101. https://doi.org/10.1007/s12262-012-0427-6 PubMed PMID: 24426401; PubMed Central PMCID: PMC3644148.CrossRefPubMed

Amri R, Dinaux AM, Leijssen LGJ, Kunitake H, Bordeianou LG, Berger DL. Do packed red blood cell transfusions really worsen oncologic outcomes in colon cancer? Surgery. 2017;162(3):586–91. https://doi.org/10.1016/j.surg.2017.03.024 PubMed PMID: 28606725.CrossRefPubMed

Morner ME, Edgren G, Martling A, Gunnarsson U, Egenvall M. Preoperative anaemia and perioperative red blood cell transfusion as prognostic factors for recurrence and mortality in colorectal cancer-a Swedish cohort study. Int J Color Dis. 2017;32(2):223–32. https://doi.org/10.1007/s00384-016-2678-3 PubMed PMID: 27770250; PubMed Central PMCID: PMC5285411.CrossRef

Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012;256(2):235–44. https://doi.org/10.1097/SLA.0b013e31825b35d5 PubMed PMID: 22791100.CrossRef

Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials. 2007;8:1.CrossRef

Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58. https://doi.org/10.1002/sim.1186 PubMed PMID: 12111919.CrossRef

Qiu L, Wang DR, Zhang XY, Gao S, Li XX, Sun GP, et al. Impact of perioperative blood transfusion on immune function and prognosis in colorectal cancer patients. Transfus Apher Sci. 2016;54(2):235–41. https://doi.org/10.1016/j.transci.2015.07.004 PubMed PMID: 26780991.CrossRefPubMed

Miki C, Hiro J, Ojima E, Inoue Y, Mohri Y, Kusunoki M. Perioperative allogeneic blood transfusion, the related cytokine response and long-term survival after potentially curative resection of colorectal cancer. Clin Oncol (R Coll Radiol). 2006;18(1):60–6 PubMed PMID: 16477921; PubMed Central PMCID: PMC16477921.CrossRef

10.

Meng J, Lu XB, Tang YX, Sun GP, Li X, Yan YF, et al. Effects of allogeneic blood transfusion in patients with stage II colon cancer. Asian Pac J Cancer Prev. 2013;14(1):347–50 PubMed PMID: 23534751; PubMed Central PMCID: PMC23534751.CrossRef

11.

Talukder Y, Stillwell AP, Siu SK, Ho YH. Comparing survival and recurrence in curative stage I to III colorectal cancer in transfused and nontransfused patients. Int Surg. 2014;99(1):8–16. https://doi.org/10.9738/INTSURG-D-13-00141.1 PubMed PMID: 24444262; PubMed Central PMCID: PMC3897348.CrossRefPubMedPubMedCentral

12.

Due SL, Wattchow DA, Sweeney JL, Milliken L, Luke CG. Colorectal cancer surgery 2000-2008: evaluation of a prospective database. ANZ J Surg. 2012;82(6):412–9. https://doi.org/10.1111/j.1445-2197.2012.06078.x PubMed PMID: 22537147.CrossRefPubMed

13.

Jagoditsch M, Pozgainer P, Klingler A, Tschmelitsch J. Impact of blood transfusions on recurrence and survival after rectal cancer surgery. Dis Colon Rectum. 2006;49(8):1116–30. https://doi.org/10.1007/s10350-006-0573-7 PubMed PMID: 16779711.CrossRefPubMed

14.

Lobaziewicz W, Kolodziejski L. The impact of homologous packed red blood cell transfusion on patients’ survival after radical surgical treatment of colorectal cancer. Acta Chir Belg. 2008;108(5):524–31 PubMed Central PMCID: PMC19051460.CrossRef

15.

Kaneko M, Sasaki S, Ishimaru K, Terai E, Nakayama H, Watanabe T. The impact of perioperative allogeneic blood transfusion on survival in elderly patients with colorectal cancer. Anticancer Res. 2015;35(6):3553–8 PubMed PMID: 26026124; PubMed Central PMCID: PMC 26026124.PubMed

16.

Nursal TZ, Hamaloglu E. The effect of preoperative blood transfusion on morbidity and survival in colorectal malignancy. The Turkish journal of gastroenterology. Turk J Gastroenterol. 2006;17(4):283–7 PubMed Central PMCID: PMC 17205407.PubMed

17.

Li XX, Meng J, Sun GP, Tang YX, Liang GF, Wang MF, et al. Effects of perioperative blood transfusion on the prognosis in hereditary and sporadic colon cancer. Biomarkers. 2015;20(6–7):481–6. https://doi.org/10.3109/1354750X.2015.1096306 PubMed PMID: 26616149.CrossRefPubMed

18.

Halabi WJ, Jafari MD, Nguyen VQ, Carmichael JC, Mills S, Pigazzi A, et al. Blood transfusions in colorectal cancer surgery: incidence, outcomes, and predictive factors: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg. 2013;206(6):1024–32. https://doi.org/10.1016/j.amjsurg.2013.10.001 discussion 32-3. PubMed PMID: 24296103.CrossRef

19.

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. https://doi.org/10.1097/SLA.0b013e318287ab4d PubMed PMID: 23470578.CrossRefPubMed

20.

Koch M, Antolovic D, Reissfelder C, Rahbari NN, Holoch J, Michalski I, et al. Leucocyte-depleted blood transfusion is an independent predictor of surgical morbidity in patients undergoing elective colon cancer surgery-a single-center analysis of 531 patients. Ann Surg Oncol. 2011;18(5):1404–11. https://doi.org/10.1245/s10434-010-1453-x PubMed PMID: 21153884.CrossRefPubMed

21.

Ghinea R, Greenberg R, White I, Sacham-Shmueli E, Mahagna H, Avital S. Perioperative blood transfusion in cancer patients undergoing laparoscopic colorectal resection: risk factors and impact on survival. Tech Coloproctol. 2013;17(5):549–54. https://doi.org/10.1007/s10151-013-1014-y PubMed PMID: 23605190.CrossRefPubMed

22.

Skanberg J, Lundholm K, Haglind E. Effects of blood transfusion with leucocyte depletion on length of hospital stay, respiratory assistance and survival after curative surgery for colorectal cancer. Acta Oncol. 2007;46(8):1123–30. https://doi.org/10.1080/02841860701441830 PubMed PMID: 17851860.CrossRefPubMed

23.

Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg. 2000;87(11):1553–62. https://doi.org/10.1046/j.1365-2168.2000.01570.x PubMed PMID: 11091245.CrossRefPubMed

24.

Patel SV, Brennan KE, Nanji S, Karim S, Merchant S, Booth CM. Peri-operative blood transfusion for resected colon cancer: practice patterns and outcomes in a population-based study. Cancer Epidemiol. 2017;51:35–40. https://doi.org/10.1016/j.canep.2017.10.006 PubMed PMID: 29032319.CrossRefPubMed

25.

van de Watering LM, Brand A, Houbiers JG, Klein Kranenbarg WM, Hermans J, van de Velde C, et al. Perioperative blood transfusions, with or without allogeneic leucocytes, relate to survival, not to cancer recurrence. Br J Surg. 2001;88(2):267–72. https://doi.org/10.1046/j.1365-2168.2001.01674.x PubMed PMID: 11167879.CrossRefPubMed

26.

Papageorge CM, Kennedy GD, Carchman EH. Preoperative blood transfusion is a predictor of worse short-term postoperative outcomes after colectomy. Surgery. 2017;161(4):1067–75. https://doi.org/10.1016/j.surg.2016.08.042 PubMed PMID: 27838105; PubMed Central PMCID: PMC5933528.CrossRefPubMed

27.

Benoist S, Panis Y, Pannegeon V, Alves A, Valleur P. Predictive factors for perioperative blood transfusions in rectal resection for cancer: a multivariate analysis of a group of 212 patients. Surgery. 2001;129(4):433–9. https://doi.org/10.1067/msy.2001.112068 PubMed PMID: 11283534.CrossRefPubMed

28.

Jensen LS, Puho E, Pedersen L, Mortensen FV, Sorensen HT. Long-term survival after colorectal surgery associated with buffy-coat-poor and leucocyte-depleted blood transfusion: a follow-up study. Lancet. 2005;365(9460):681–2. https://doi.org/10.1016/S0140-6736(05)17949-5 PubMed PMID: 15721474.CrossRefPubMed

29.

Mynster T, Nielsen HJ. Danish RANX05 Colorectal Cancer Study Group. Storage time of transfused blood and disease recurrence after colorectal cancer surgery. Dis Colon Rectum. 2001;44(7):955–64 PubMed PMID: 11496075; PubMed Central PMCID: PMC11496075.CrossRef

30.

Aquina CT, Blumberg N, Becerra AZ, Boscoe FP, Schymura MJ, Noyes K, et al. Association among blood transfusion, sepsis, and decreased long-term survival after colon cancer resection. Ann Surg. 2017;266(2):311–7. https://doi.org/10.1097/SLA.0000000000001990 PubMed PMID: 27631770.CrossRefPubMed

31.

Mazzeffi M, Tanaka K, Galvagno S. Red blood cell transfusion and surgical site infection after colon resection surgery: a cohort study. Anesth Analg. 2017;125(4):1316–21. https://doi.org/10.1213/ANE.0000000000002099 PubMed PMID: 28504993.CrossRefPubMed

32.

Van Osdol AD, Borgert AJ, Kallies KJ, Froman JP, Bottner WA, Shapiro SB. Long-term outcomes of an integrated transfusion reduction initiative in patients undergoing resection for colorectal cancer. Am J Surg. 2015;210(6):990–4. https://doi.org/10.1016/j.amjsurg.2015.06.026 discussion 5.PubMed PMID: 26455522.CrossRefPubMed

33.

Sanchez-Velazquez P, Pera M, Jimenez-Toscano M, Mayol X, Roges X, Lorente L, et al. Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer. Clin Transl Oncol. 2018. https://doi.org/10.1007/s12094-018-1866-8 PubMed PMID: 29623587.

34.

Molland G, Dent OF, Chapuis PH, Bokey EL, Nicholls M, Newland RC. Transfusion does not influence patient survival after resection of colorectal cancer. Aust N Z J Surg. 1995;65:592–5 PubMed Central PMCID: PMC7661803.CrossRef

35.

Cheslyn-Curtis S, Fielding LP, Hittinger R, Fry JS, Phillips RK. Large bowel cancer: the effect of perioperative blood transfusion on outcome. Ann R Coll Surg Engl. 1990;72(1):53–9 PubMed PMID: 2405765; PubMed Central PMCID: PMC2499079.PubMedPubMedCentral

36.

Donohue JH, Williams S, Cha S, Windschitl HE, Witzig TE, Nelson H, et al. Perioperative blood transfusions do not affect disease recurrence of patients undergoing curative resection of colorectal carcinoma: a Mayo/North Central Cancer Treatment Group study. J Clin Oncol. 1995;13(7):1671–8. https://doi.org/10.1200/JCO.1995.13.7.1671 PubMed PMID: 7602357.CrossRefPubMed

37.

Tratter PI. The association of perioperative blood transfusion with colorectal cancer recurrence. Ann Surg. 1992;216:633–8 PubMed Central PMCID: PMC1466616.CrossRef

38.

Garau I, Benito E, Bosch FX, et al. Blood transfusion has no effect on colorectal cancer survival. A Population-based Study Eur J Cancer. 1994;30A:759–64 PubMed Central PMCID: PMC7917533.PubMed

39.

Edna TH, Bjerkeset T. Perioperative blood transfusions reduce long-term survival following surgery for colorectal cancer. Dis Colon Rectum. 1998;41(4):451–9 PubMed PMID: 9559629.CrossRef

40.

Pages F, Berger A, Camus M, Sanchez-Cabo F, Costes A, Molidor R, et al. Effector memory T cells, early metastasis, and survival in colorectal cancer. N Engl J Med. 2005;353(25):2654–66. https://doi.org/10.1056/NEJMoa051424 PubMed PMID: 16371631.CrossRefPubMed

41.

Galon J, Costes A, Sanchez-Cabo F, Kirilovsky A, Mlecnik B, Lagorce-Pages C, et al. Type, density, and location of immune cells within human colorectal tumors predict clinical outcome. Science. 2006;313(5795):1960–4. https://doi.org/10.1126/science.1129139 PubMed PMID: 17008531.CrossRef

42.

Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013;110(5):690–701. https://doi.org/10.1093/bja/aet068 PubMed PMID: 23599512; PubMed Central PMCID: PMC3630286.CrossRefPubMedPubMedCentral

43.

Atzil S, Arad M, Glasner A, Abiri N, Avraham R, Greenfeld K, et al. Blood transfusion promotes cancer progression: a critical role for aged erythrocytes. Anesthesiology. 2008;109(6):989–97. https://doi.org/10.1097/ALN.0b013e31818ddb72 PubMed PMID: 19034095; PubMed Central PMCID: PMC2694914.CrossRefPubMedPubMedCentral

44.

Jensen LS, Andersen AJ, Christiansen PM, Hokland P, Juhl CO, Madsen G, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg. 1992;79(6):513–6 PubMed PMID: 1611441.CrossRef

45.

Patel HB, Nasir FA, Nash GF, Scully MF, Kakkar AK. Enhanced angiogenesis following allogeneic blood transfusion. Clin Lab Haematol. 2004;26(2):129–35. https://doi.org/10.1111/j.1365-2257.2004.00589.x PubMed PMID: 15053807.CrossRefPubMed

46.

Ben-Eliyahu S. The promotion of tumor metastasis by surgery and stress: immunological basis and implications for psychoneuroimmunology. Brain Behav Immun. 2003;17(Suppl 1):S27–36 PubMed Central PMCID: PMC12615183.CrossRef

47.

Horowitz M, Neeman E, Sharon E, Ben-Eliyahu S. Exploiting the critical perioperative period to improve long-term cancer outcomes. Nat Rev Clin Oncol. 2015;12(4):213–26. https://doi.org/10.1038/nrclinonc.2014.224 PubMed PMID: 25601442; PubMed Central PMCID: PMC5497123.CrossRefPubMedPubMedCentral

48.

Carson JL, Sieber F, Cook DR, Hoover DR, Noveck H, Chaitman BR, et al. Liberal versus restrictive blood transfusion strategy: 3-year survival and cause of death results from the FOCUS randomised controlled trial. Lancet. 2015;385(9974):1183–9. https://doi.org/10.1016/S0140-6736(14)62286-8 PubMed PMID: 25499165; PubMed Central PMCID: PMC4498804.CrossRefPubMed

49.

Leichtle SW, Mouawad NJ, Lampman R, Singal B, Cleary RK. Does preoperative anemia adversely affect colon and rectal surgery outcomes? J Am Coll Surg. 2011;212(2):187–94. https://doi.org/10.1016/j.jamcollsurg.2010.09.013 PubMed PMID: 21276532.CrossRefPubMed

50.

Glechner A, Gartlehner G, Nussbaumer B, Kozek-Langenecker S. Perioperative anemia management: a systematic review and meta-analysis. Wien Med Wochenschr. 2014;164(15–16):330–41. https://doi.org/10.1007/s10354-014-0293-x PubMed PMID: 25168917.CrossRefPubMed

51.

Chen G, Zhang FJ, Gong M, Yan M. Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients. J Zhejiang Univ Sci B. 2007;8(8):560–5. https://doi.org/10.1631/jzus.2007.B0560 PubMed PMID: 17657857; PubMed Central PMCID: PMC1934950.CrossRefPubMedPubMedCentral

52.

Xing YL, Wang YC. Influence of autologous and homologous blood transfusion on interleukins and tumor necrosis factor-alpha in peri-operative patients with esophageal cancer. Asian Pacific journal of cancer prevention. Asian Pac J Cancer Prev. 2014;15(18):7831–4 PubMed Central PMCID: PMC25292072.CrossRef

53.

Harlaar JJ, Gosselink MP, Hop WC, Lange JF, Busch OR, Jeekel H. Blood transfusions and prognosis in colorectal cancer: long-term results of a randomized controlled trial. Ann Surg. 2012;256(5):681–6. https://doi.org/10.1097/SLA.0b013e318271cedf discussion 6-7e. PubMed PMID: 23095610.CrossRefPubMed

Title: Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis
Authors: Qian-Yun Pang
Ran An
Hong-Liang Liu
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Colorectal Cancer
Colorectal Cancer
Published in: World Journal of Surgical Oncology / Issue 1/2019
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-018-1551-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perioperative transfusion and the prognosis of colorectal cancer surgery: a systematic review and meta-analysis

Abstract

Background

Objective

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2019

Local excision followed by early radical surgery in rectal cancer: long-term outcome

Retrograde installation of percutaneous transhepatic negative-pressure biliary drainage stabilizes pancreaticojejunostomy after pancreaticoduodenectomy: a retrospective cohort study

Chondroblastoma of the patella with pathological fracture in an adolescent: a case report

Optimal use of antiplatelet agents, especially aspirin, in the perioperative management of colorectal cancer patients undergoing laparoscopic colorectal resection

Retraction Note: Diagnostic and prognostic value of plasma microRNA-195 in patients with non-small cell lung cancer

Prognostic role of pretreatment thrombocytosis on survival in patients with cervical cancer: a systematic review and meta-analysis