Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 643-654
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.643
Risk factors for blood transfusion and its prognostic implications in curative gastrectomy for gastric cancer
Lucas Eiki Kawakami, Pedro Barzan Bonomi, Marina Alessandra Pereira, Fabrício Oliveira Carvalho, Ulysses Ribeiro Jr, Bruno Zilberstein, Luciana Ribeiro Sampaio, Luiz Augusto Carneiro-D'Albuquerque, Marcus Fernando Kodama Pertille Ramos
Lucas Eiki Kawakami, Pedro Barzan Bonomi, Marina Alessandra Pereira, Ulysses Ribeiro Jr, Bruno Zilberstein, Luiz Augusto Carneiro-D'Albuquerque, Marcus Fernando Kodama Pertille Ramos, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil
Fabrício Oliveira Carvalho, Luciana Ribeiro Sampaio, Blood Transfusion Unit, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 01249000, Brazil
Author contributions: Kawakami LE and Bonomi PB contributed to data retrieval, critical analysis, and manuscript drafting; Pereira MA contributed to data retrieval, critical analysis, statistical analysis, and manuscript review; Carvalho FO and Sampaio LR contributed to data retrieval and manuscript review; Ribeiro Jr. U, Zilberstein B, and Carneiro-D'Albuquerque LA contributed to critical analysis and manuscript review; Ramos MFKP contributed to study design, data retrieval, critical analysis, and manuscript drafting.
Institutional review board statement: The study was approved by the Hospital Ethics Committee and registered online (https://plataformabrasil.saude.gov.br; CAAE: 59337222.7.0000.0068).
Informed consent statement: Informed consent was waived by the local ethics committee, given the study's retrospective nature.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
Data sharing statement: No additional data are available.
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: Marcus Fernando Kodama Pertille Ramos, PhD, Doctor, Surgical Oncologist, Department of Gastroenterology, Instituto do Cancer, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av Dr Arnaldo, 251, Sao Paulo 01249000, Brazil. marcus.kodama@hc.fm.usp.br
Received: December 23, 2022
Peer-review started: December 23, 2022
First decision: February 3, 2023
Revised: February 12, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: April 27, 2023
ARTICLE HIGHLIGHTS
Research background

Anemia and intraoperative blood loss are frequent issues in gastric cancer (GC) surgical treatment. The current literature still debates the impact of perioperative blood transfusion on GC survival.

Research motivation

Red blood cell (RBC) transfusions are sometimes required for patients undergoing surgery for GC. However, the prognostic impact of perioperative RBC transfusion in GC is controversial.

Research objectives

We analyzed the influence of RBC transfusions on the prognosis of patients with gastric adenocarcinoma undergoing gastrectomy with curative intention.

Research methods

We retrospectively evaluated all GC patients who underwent gastrectomy between 2009 and 2021. Patients were divided into transfusion group and non-transfusion group for analysis. RBC transfusions that occurred intraoperatively and postoperatively within 30 d were considered.

Research results

A total of 718 patients were included, and 189 (26.3%) patients received RBC transfusions. Patients who received transfusions had unfavorable clinical and pathological characteristics, and underwent more extensive surgical procedures. Patients who received RBC transfusions had worse survival compared to those who did not. In multivariate analysis, receiving an RCB transfusion was an independent factor associated with poor disease-free survival (DFS) and overall survival (OS).

Research conclusions

Even though the patients who receive RCB transfusion have worse clinical conditions, we found that perioperative transfusion represents an independent factor associated with poor prognosis, with worse DFS and OS.

Research perspectives

The application of blood component transfusion in randomized clinical trials presents ethical limitations; however, the current design of retrospective studies still interferes with controlling confounding factors. With this study, we endorse a favorable position for increasing preoperative and postoperative care to avoid RBC transfusion. Further, our findings provide additional data for future meta-analysis.