Fei H, Zhang XJ, Sun CY, Li Z, Li ZF, Guo CG, Zhao DB. Impact of perioperative blood transfusion on oncological outcomes in ampullary carcinoma patients underwent pancreaticoduodenectomy. World J Gastrointest Surg 2023; 15(7): 1363-1374 [PMID: PMC10405114 DOI: 10.4240/wjgs.v15.i7.1363]
Corresponding Author of This Article
Dong-Bing Zhao, MD, Professor, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. dbzhao@cicams.ac.cn
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
He Fei, Xiao-Jie Zhang, Chong-Yuan Sun, Zheng Li, Ze-Feng Li, Chun-Guang Guo, Dong-Bing Zhao, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Fei H and Zhang XJ contributed equally to this work; Guo CG and Zhao DB designed the research study; Fei H and Zhang XJ analyzed the data; all authors wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College Ethics Committee.
Informed consent statement: Ethical review and approval were not required for the study on human participants in accordance the local legislation and institutional requirements.
Conflict-of-interest statement: None of the authors have conflicts of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dong-Bing Zhao, MD, Professor, Department of Pancreatic and Gastric Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Beijing 100021, China. dbzhao@cicams.ac.cn
Received: February 1, 2023 Peer-review started: February 1, 2023 First decision: February 14, 2023 Revised: March 5, 2023 Accepted: May 17, 2023 Article in press: May 17, 2023 Published online: July 27, 2023 Processing time: 170 Days and 0.7 Hours
Abstract
BACKGROUND
The effect of perioperative blood transfusion (PBT) on the prognosis of ampullary carcinoma (AC) is still debated.
AIM
To explore the impact of PBT on short-term safety and long-term survival in AC patients who underwent pancreaticoduodenectomy.
METHODS
A total of 257 patients with AC who underwent pancreaticoduodenectomy between 1998 and 2020 in the Cancer Hospital, Chinese Academy of Medical Sciences, were retrospectively analyzed. We used Cox proportional hazard regression to identify prognostic factors of overall survival (OS) and recurrence-free survival (RFS) and the Kaplan-Meier method to analyze survival information.
RESULTS
A total of 144 (56%) of 257 patients received PBT. The PBT group and nonperioperative blood transfusion group showed no significant differences in demographics. Patients who received transfusion had a comparable incidence of postoperative complications with patients who did not. Univariable and multivariable Cox proportional hazard regression analyses indicated that transfusion was not an independent predictor of OS or RFS. We performed Kaplan-Meier analysis according to subgroups of T stage, and subgroup analysis indicated that PBT might be associated with worse OS (P < 0.05) but not RFS in AC of stage T1.
CONCLUSION
We found that PBT might be associated with decreased OS in early AC, but more validation is needed. The reasonable use of transfusion might be helpful to improve OS.
Core Tip: Considering that few researches on ampullary carcinoma (AC) and high proportion of transfusion on patients undergoing pancreatic surgery due to the sophisticated surgical procedure, we conducted a retrospective study to elucidate the influence of transfusion on short-term safety and long-term survival after curative resection of AC. We found that transfusion might be potentially associated with decreased overall survival in early AC patients. The current article might provide guidance for the reasonable use of transfusion and possible direction for further mechanism study.
