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Journal of Gastrointestinal Surgery
Published in: Journal of Gastrointestinal Surgery 5/2015

Open Access 01-05-2015 | Original Article

Perioperative Blood Transfusion as a Poor Prognostic Factor After Aggressive Surgical Resection for Hilar Cholangiocarcinoma

Authors: Norihisa Kimura, Yoshikazu Toyoki, Keinosuke Ishido, Daisuke Kudo, Yuta Yakoshi, Shinji Tsutsumi, Takuya Miura, Taiichi Wakiya, Kenichi Hakamada

Published in: Journal of Gastrointestinal Surgery | Issue 5/2015

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Abstract

Background

Blood transfusion is linked to a negative outcome for malignant tumors. The aim of this study was to evaluate aggressive surgical resection for hilar cholangiocarcinoma (HCCA) and assess the impact of perioperative blood transfusion on long-term survival.

Methods

Sixty-six consecutive major hepatectomies with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA were performed using macroscopically curative resection at our institute from 2002 to 2012. Clinicopathologic factors for recurrence and survival were retrospectively assessed.

Results

Overall survival rates at 1, 3, and 5 years were 86.7, 47.3, and 35.7 %, respectively. In univariate analysis, perioperative blood transfusion and a histological positive margin were two of several variables found to be significant prognostic factors for recurrence or survival (P < 0.05). In multivariate analysis, only perioperative blood transfusion was independently associated with recurrence (hazard ratio (HR) = 2.839 (95 % confidence interval (CI), 1.370–5.884), P = 0.005), while perioperative blood transfusion (HR = 3.383 (95 % CI, 1.499–7.637), P = 0.003) and R1 resection (HR = 3.125 (95 % CI, 1.025–9.530), P = 0.045) were independent risk factors for poor survival.

Conclusions

Perioperative blood transfusion is a strong predictor of poor survival after radical hepatectomy for HCCA. We suggest that circumvention of perioperative blood transfusion can play an important role in long-term survival for patients with HCCA.
Literature
1.
Klempnauer J, Ridder GJ, Werner M, et al. What constitutes long-term survival after surgery for hilar cholangiocarcinoma? Cancer 1997; 79:26–34.CrossRefPubMed
2.
3.
Rea DJ, Heimbach JK, Rosen CB, et al. Liver transplantation with neoadjuvant chemoradiation is more effective than resection for hilar cholangiocarcinoma. Ann Surg 2005;242:451–458.PubMedCentralPubMed
4.
Nimura Y, Hayakawa N, Kamiya J, et al. Hepatic segmentectomy with caudate lobe resection for bile duct carcinoma of the hepatic hilus. World J Surg 1990; 14:535–544.CrossRefPubMed
5.
Washburn WK, Lewis WD, Jenkins RL. Aggressive surgical resection for cholangiocarcinoma. Arch Surg 1995; 130:270–276.CrossRefPubMed
6.
7.
Jarnagin WR, Fong Y, DeMatteo RP, et al. Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma. Ann Surg 2001; 234:507–519.CrossRefPubMedCentralPubMed
8.
Kitagawa Y, Nagino M, Kamiya J, et al. Lymph node metastasis from hilar cholangiocarcinoma: audit of 110 patients who underwent regional and paraaortic node dissection. Ann Surg 2001; 233:385–392.CrossRefPubMedCentralPubMed
9.
Nimura Y, Hayakawa N, Kamiya J, et al. Combined portal vein and liver resection for carcinoma of the biliary tract. Br J Surg 1991; 78:727–731.CrossRefPubMed
10.
Ebata T, Nagino M, Kamiya J, et al. Hepatectomy with portal vein resection for hilar cholangiocarcinoma: audit of 52 consecutive cases. Ann Surg 2003; 238:720–727.CrossRefPubMedCentralPubMed
11.
Sakamoto Y, Sano T, Shimada K, et al. Clinical significance of reconstruction of the right hepatic artery for biliary malignancy. Langenbecks Arch Surg 2006; 391:203–208.CrossRefPubMed
12.
Nagino M, Nimura Y, Nishio H, et al. Hepatectomy with simultaneous resection of the portal vein and hepatic artery for advanced perihilar cholangiocarcinoma: an audit of 50 consecutive cases. Ann Surg 2010; 252:115–23.CrossRefPubMed
13.
Makuuchi M, Thai BL, Takayasu K, et al. Preoperative portal embolization to increase safety of major hepatectomy for hilar bile duct carcinoma: a preliminary report. Surgery 1990; 107:521–527.PubMed
14.
Imamura H, Shimada R, Kubota M, et al. Preoperative portal vein embolization: an audit of 84 patients. Hepatology 1999; 29:1099–1105.CrossRefPubMed
15.
Abdalla EK, Barnett CC, Doherty D, et al. Extended hepatectomy in patients with hepatobiliary malignancies with and without preoperative portal vein embolization. Arch Surg 2002; 137:675–681.CrossRefPubMed
16.
Kawasaki S, Imamura H, Kobayashi A, et al. Results of surgical resection for patients with hilar bile duct cancer: application of extended hepatectomy after biliary drainage and hemihepatic portal vein embolization. Ann Surg 2003; 238:84–92.PubMedCentralPubMed
17.
18.
Nagino M, Kamiya J, Nishio H, et al. Two hundred forty consecutive portal vein embolizations before extended hepatectomy for biliary cancer: surgical outcome and long-term follow-up. Ann Surg 2006; 243:364–372.CrossRefPubMedCentralPubMed
19.
Kosuge T, Yamamoto J, Shimada K, et al. Improved surgical results for hilar cholangiocarcinoma with procedures including major hepatic resection. Ann Surg 1999; 230:663–671.CrossRefPubMedCentralPubMed
20.
de Boer MT, Molenaar IQ, Porte RJ. Impact of blood loss on outcome after liver resection. Dig Surg 2007; 24:259–264.CrossRefPubMed
21.
Nagino M, Nimura Y, Kamiya J, et al. Changes in hepatic lobe volume in biliary tract cancer patients after right portal vein embolization. Hepatology 1995; 21:434–439.PubMed
22.
Uesaka K, Nimura Y, Nagino M. Changes in hepatic lobar function after right portal vein embolization. An appraisal by biliary indocyanine green excretion. Ann Surg 1996; 223:77–83.CrossRefPubMedCentralPubMed
23.
Nimura Y, Hayakawa N, Kamiya J, et al. Hepatopancreatoduodenectomy for advanced carcinoma of the biliary tract. Hepatogastroenterology 1991; 38:170–175.PubMed
24.
Miyazaki M, Kato A, Ito H, et al. Combined vascular resection in operative resection for hilar cholangiocarcinoma: does it work or not? Surgery 2007; 141:581–588.CrossRefPubMed
25.
Gerhards MF, van Gulik TM, de Wit LT, et al. Evaluation of morbidity and mortality after resection for hilar cholangiocarcinoma—a single center experience. Surgery 2000; 127:395–404.CrossRefPubMed
26.
Shimizu H, Kimura F, Yoshidome H, et al. Aggressive surgical resection for hilar cholangiocarcinoma of the left-side predominance: radicality and safety of left-sided hepatectomy. Ann Surg 2010; 251:281–286.CrossRefPubMed
27.
International Union Against Cancer (UICC). TNM classification of malignant tumours. 7th ed. Hoboken, NJ: Wiley-Blackwell, 2009.
28.
Albores-Saavedra J, Henson D, Klimstra D. Tumors of the gallbladder, extrahepatic bile ducts, and ampulla of Vater. 3rd ed. Washington, DC: Armed Forces Institute of Pathology, 2000.
29.
Wakai T, Shirai Y, Moroda T, et al. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005; 103:1210–1216.CrossRefPubMed
30.
Sasaki R, Takeda Y, Funato O, et al. Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg 2007; 31:1788–1796.CrossRefPubMed
31.
Endo I, House MG, Klimstra DS, et al. Clinical significance of intraoperative bile duct margin assessment for hilar cholangiocarcinoma. Ann Surg Oncol 2008; 15:2104–2112.CrossRefPubMed
32.
Ojima H, Kanai Y, Iwasaki M, et al. Intraductal carcinoma component as a favorable prognostic factor in biliary tract carcinoma. Cancer Sci 2009; 100:62–70.CrossRefPubMed
33.
Nakanishi Y, Kondo S, Zen Y, et al. Impact of residual in situ carcinoma on postoperative survival in 125 patients with extrahepatic bile duct carcinoma. J Hepatobiliary Pancreat Sci 2010; 17:166–173.CrossRefPubMed
34.
Igami T, Nagino M, Oda K, et al. Clinicopathologic study of cholangiocarcinoma with superficial spread. Ann Surg 2009; 249:296–302.CrossRefPubMed
35.
Mullen JT, Ribero D, Reddy SK, et al. Hepatic insufficiency and mortality in 1,059 noncirrhotic patients undergoing major hepatectomy. J Am Coll Surg 2007; 204:854–864.CrossRefPubMed
36.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–213.CrossRefPubMedCentralPubMed
37.
Ito F, Cho CS, Rikkers LF, Weber SM. Hilar cholangiocarcinoma: current management. Ann Surg 2009; 250:210–218.CrossRefPubMed
38.
Seyama Y, Kubota K, Sano K, et al. Long-term outcome of extended hemihepatectomy for hilar bile duct cancer with no mortality and high survival rate. Ann Surg 2003; 238:73–83.PubMedCentralPubMed
39.
Jarnagin WR, Bowne W, Klimstra DS, et al. Papillary phenotype confers improved survival after resection of hilar cholangiocarcinoma. Ann Surg 2005; 241:703–714.CrossRefPubMedCentralPubMed
40.
Hasegawa S, Ikai I, Fujii H, et al. Surgical resection of hilar cholangiocarcinoma: analysis of survival and postoperative complications. World J Surg 2007; 31:1256–1263.CrossRefPubMed
41.
Klempnauer J, Ridder GJ, von Wasielewski R, et al. Resectional surgery of hilar cholangiocarcinoma: a multivariate analysis of prognostic factors. J Clin Oncol 1997; 15:947–954.PubMed
42.
Miyazaki M, Ito H, Nakagawa K, et al. Aggressive surgical approaches to hilar cholangiocarcinoma: hepatic or local resection? Surgery 1998; 123:131–136.CrossRefPubMed
43.
Su CH, Tsay SH, Wu CC, et al. Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma. Ann Surg 1996; 223:384–394.CrossRefPubMedCentralPubMed
44.
Todoroki T, Kawamoto T, Koike N, et al. Radical resection of hilar bile duct carcinoma and predictors of survival. Br J Surg 2000; 87:306–313.CrossRefPubMed
45.
Tsao JI, Nimura Y, Kamiya J, et al. Management of hilar cholangiocarcinoma: comparison of an American and a Japanese experience. Ann Surg 2000; 232:166–174.CrossRefPubMedCentralPubMed
46.
Igami T, Nishio H, Ebata T, et al. Surgical treatment of hilar cholangiocarcinoma in the “new era”: the Nagoya University experience. J Hepatobiliary Pancreat Sci 2010; 17:449–454.CrossRefPubMed
47.
Ito F, Agni R, Rettammel RJ, et al. Resection of hilar cholangiocarcinoma: concomitant liver resection decreases hepatic recurrence. Ann Surg 2008; 248:273–279.CrossRefPubMed
48.
Opelz G, Terasaki PI. Absence of immunization effect in human-kidney retransplantation. N Engl J Med 1978; 299:369–374.CrossRefPubMed
49.
Peters WR, Fry RD, Fleshman JW, Kodner IJ. Multiple blood transfusions reduce the recurrence rate of Crohn's disease. Dis Colon Rectum 1989; 32:749–753.CrossRefPubMed
50.
Burrows L, Tartter P. Effect of blood transfusions on colonic malignancy recurrent rate. Lancet 1982; 2(8299):662–662.CrossRefPubMed
51.
Voogt PJ, van de Velde CJ, Brand A, et al. Perioperative blood transfusion and cancer prognosis. Different effects of blood transfusion on prognosis of colon and breast cancer patients. Cancer 1987; 59:836–843.CrossRefPubMed
52.
Blumberg N, Agarwal MM, Chuang C. Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985; 290:1037–1039.CrossRef
53.
Foster RS, Jr., Costanza MC, Foster JC, et al. Adverse relationship between blood transfusions and survival after colectomy for colon cancer. Cancer 1985; 55:1195–1201.CrossRefPubMed
54.
Parrott NR, Lennard TW, Taylor RM, et al. Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br J Surg 1986; 73:970–973.CrossRefPubMed
55.
56.
Heiss MM, Mempel W, Delanoff C, et al. Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol 1994; 12:1859–1867.PubMed
57.
Busch OR, Hop WC, Marquet RL, Jeekel J. The effect of blood transfusions on survival after surgery for colorectal cancer. Eur J Cancer 1995; 31A:1226–1228.CrossRefPubMed
58.
Kaneda M, Horimi T, Ninomiya M, et al. Adverse affect of blood transfusions on survival of patients with gastric cancer. Transfusion 1987; 27:375–377.CrossRefPubMed
59.
Fong Y, Karpeh M, Mayer K, Brennan MF. Association of perioperative transfusions with poor outcome in resection of gastric adenocarcinoma. Am J Surg 1994; 167:256–260.CrossRefPubMed
60.
Hyung WJ, Noh SH, Shin DW, et al. Adverse effects of perioperative transfusion on patients with stage III and IV gastric cancer. Ann Surg Oncol 2002; 9:5–12.CrossRefPubMed
61.
Cameron JL, Crist DW, Sitzmann JV, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg 1991; 161:120–125.CrossRefPubMed
62.
Millikan KW, Deziel DJ, Silverstein JC, et al. Prognostic factors associated with resectable adenocarcinoma of the head of the pancreas. Am Surg 1999; 65:618–624.PubMed
63.
Yeh JJ, Gonen M, Tomlinson JS, et al. Effect of blood transfusion on outcome after pancreaticoduodenectomy for exocrine tumour of the pancreas. Br J Surg 2007; 94:466–472.CrossRefPubMed
64.
Ueda M, Endo I, Nakashima M, et al. Prognostic factors after resection of pancreatic cancer. World J Surg 2009; 33:104–110.CrossRefPubMed
65.
Kneuertz PJ, Patel SH, Chu CK, et al. Effects of perioperative red blood cell transfusion on disease recurrence and survival after pancreaticoduodenectomy for ductal adenocarcinoma. Ann Surg Oncol 2011; 18:1327–1334.CrossRefPubMed
66.
Gozzetti G, Mazziotti A, Grazi GL, et al. Liver resection without blood transfusion. Br J Surg 1995; 82:1105–1110.CrossRefPubMed
67.
Asahara T, Katayama K, Itamoto T, et al. Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma. World J Surg 1999; 23:676–680.CrossRefPubMed
68.
Yamamoto J, Kosuge T, Takayama T, et al. Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 1994; 115:303–309.PubMed
69.
Poon RT, Fan ST, Lo CM, et al. Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 2001; 234:63–70.CrossRefPubMedCentralPubMed
70.
Shiba H, Ishida Y, Wakiyama S, et al. Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg 2009; 13:1636–1642.CrossRefPubMed
71.
Wang CC, Iyer SG, Low JK, et al. Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 2009; 16:1832–1842.CrossRefPubMed
72.
Stephenson KR, Steinberg SM, Hughes KS, et al. Perioperative blood transfusions are associated with decreased time to recurrence and decreased survival after resection of colorectal liver metastases. Ann Surg 1988; 208:679–687.CrossRefPubMedCentralPubMed
73.
Kooby DA, Stockman J, Ben-Porat L, et al. Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 2003; 237:860–870.PubMedCentralPubMed
74.
Poon RT, Fan ST, Lo CM, et al. Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 2004; 240:698–710.PubMedCentralPubMed
75.
Gomez D, Morris-Stiff G, Wyatt J, et al. Surgical technique and systemic inflammation influences long-term disease-free survival following hepatic resection for colorectal metastasis. J Surg Oncol 2008; 98:371–376.CrossRefPubMed
76.
Nagino M, Kamiya J, Arai T, et al. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery 2005; 137:148–155.CrossRefPubMed
77.
Regimbeau JM, Fuks D, Le Treut YP, et al. Surgery for hilar cholangiocarcinoma: a multi-institutional update on practice and outcome by the AFC-HC study group. J Gastrointest Surg 2011; 15:480–488.CrossRefPubMed
78.
Nuzzo G, Giuliante F, Ardito F, et al. Improvement in perioperative and long-term outcome after surgical treatment of hilar cholangiocarcinoma: results of an Italian multicenter analysis of 440 patients. Arch Surg 2012; 147:26–34.CrossRefPubMed
79.
Liu CL, Fan ST, Lo CM, et al. Improved operative and survival outcomes of surgical treatment for hilar cholangiocarcinoma. Br J Surg 2006; 93:1488–1494.CrossRefPubMed
80.
Young AL, Igami T, Senda Y, et al. Evolution of the surgical management of perihilar cholangiocarcinoma in a Western centre demonstrates improved survival with endoscopic biliary drainage and reduced use of blood transfusion. HPB (Oxford) 2011; 13:483–493.CrossRef
81.
Gascon P, Zoumbos NC, Young NS. Immunologic abnormalities in patients receiving multiple blood transfusions. Ann Intern Med 1984; 100:173–177.CrossRefPubMed
82.
Kaplan J, Sarnaik S, Gitlin J, Lusher J. Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood 1984; 64:308–310.PubMed
83.
Upile T, Jerjes W, Mahil J, et al. An explanation for the worsened prognosis in some cancer patients of perioperative transfusion: the time-dependent release of biologically active growth factors from stored blood products. Eur Arch Otorhinolaryngol 2011; 268:1789–1794.CrossRefPubMed
84.
Goeppert B, Frauenschuh L, Zucknick M, et al. Prognostic impact of tumour-infiltrating immune cells on biliary tract cancer. Br J Cancer 2013; 109:2665–2674CrossRefPubMedCentralPubMed
Metadata
Title
Perioperative Blood Transfusion as a Poor Prognostic Factor After Aggressive Surgical Resection for Hilar Cholangiocarcinoma
Authors
Norihisa Kimura
Yoshikazu Toyoki
Keinosuke Ishido
Daisuke Kudo
Yuta Yakoshi
Shinji Tsutsumi
Takuya Miura
Taiichi Wakiya
Kenichi Hakamada
Publication date
01-05-2015
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 5/2015
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-014-2741-8

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