Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.643
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
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.
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.
We analyzed the influence of RBC transfusions on the prognosis of patients with gastric adenocarcinoma undergoing gastrectomy with curative intention.
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.
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).
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.
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.