Impact of perioperative blood transfusion on oncological outcomes in ampullary carcinoma patients underwent pancreaticoduodenectomy

Table 1 The clinicopathologic characteristics of the ampullary carcinoma patients in the perioperative blood transfusion group and no perioperative blood transfusion group

Characteristic	No PBT		PBT		P value
	n = 113	100%	n = 144	100%
Sex					0.527
Male	62	54.9%	85	59.0%
Female	51	45.1%	59	41.0%
Age (yr)					0.527
≤ 60	60	53.1%	83	57.6%
> 60	53	46.9%	61	42.4%
Operation time					> 0.999
≤ 6 h	85	75.2%	109	75.0%
> 6 h	28	24.8%	35	25.0%
Tumor size (cm)					0.901
≤ 2.0 cm	56	49.6%	70	48.6%
> 2.0 cm	57	50.4%	74	51.4%
Differentiation					0.677
Well	27	23.9%	34	23.6%
Moderate	47	47%	67	46.5%
Poor	39	34.5%	43	29.9%
T stage					0.300
T1	22	19.5%	18	12.5%
T2	41	36.3%	59	41.0%
T3	50	44.2%	67	46.5%
N stage					0.346
N0	82	72.6%	108	75.0%
N1	28	24.8%	28	19.4%
N2	3	2.7%	8	5.6%
Blood vessel invasion					0.200
No	87	77.0%	121	84.0%
Yes	26	23.0%	23	16.0%
Postoperative complications					0.699
No	71	62.8%	86	59.7%
Yes	42	37.2%	58	40.3%
Adjuvant treatment					0.663
No	87	77.0%	107	74.3%
Yes	26	23.0%	37	25.7%

PBT: Perioperative blood transfusion.

Table 2 The postoperative complications of the ampullary carcinoma patients in the perioperative blood transfusion group and no perioperative blood transfusion group

Characteristic	No PBT		PBT		P value
	n = 113	100%	n = 144	100%
Postoperative complications					0.699
No	71	62.8%	86	59.7%
Yes	42	37.2%	58	40.3%
Specific complications
PPH	10	8.8%	13	9.0%	0.960
POPF	16	14.2%	22	15.3%	0.802
DGE	11	9.7%	13	9.0%	0.847
Intra-abdominal infection	15	13.3%	14	9.7%	0.372

PBT: Perioperative blood transfusion; POPF: Postoperative pancreatic fistula; PPH: Postpancreatectomy hemorrhage; DGE: Delayed gastric emptying.

Table 3 Univariable and multivariable Cox regression analyses of overall survival in ampullary carcinoma patients

Characteristic	Univariable analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Perioperative blood transfusion
No	Reference		Reference
Yes	0.937 (0.626-1.339)	0.723	0.975 (0.676-1.405)	0.891
RBC units
0	Reference
1-4 units	0.924 (0.643-1.329)	0.671
≥ 5 units	1.139 (0.455-2.851)	0.781
Sex
Male	Reference
Female	0.868 (0.606-1.244)	0.441
Age (yr)
≤ 60	Reference		Reference
> 60	0.535 (0.371-0.774)	0.001	1.541 (0.698-3.400)	0.284
Operation time
≤ 6 h	Reference
> 6 h	1.260 (0.840-1.892)	0.264
Tumor size (cm)
≤ 2.0 cm	Reference		Reference
> 2.0 cm	1.337 (0.939-1.903)	0.107	1.105 (0.756-1.614)	0.608
Differentiation
Well	Reference		Reference
Moderate	0.895 (0.603-1.330)	0.584	0.969 (0.637-1.474)	0.883
Poor	0.593 (0.360-0.977)	0.040	0.967 (0.529-1.766)	0.913
T stage
T1	Reference		Reference
T2	1.407 (0.770-2.569)	0.267	1.282 (0.660-2.491)	0.463
T3	2.796 (1.564-4.997)	0.001	3.024 (1.245-7.341)	0.014
N stage
N0	Reference		Reference
N1	1.986 (1.336-2.953)	0.001	2.072 (1.240-3.465)	0.021
N2	2.119 (0.977-4.595)	0.057	1.988 (0.820-4.817)	0.128
Blood vessel invasion
No	Reference		Reference
Yes	1.616 (0.054-2.478)	0.028	1.087 (0.669-1.766)	0.737
Postoperative complications
No	Reference		Reference
Yes	1.358 (0.950-1.943)	0.093	1.345 (0.930-1.946)	0.116
Adjuvant treatment
No	Reference
Yes	1.056 (0.702-1.588)	0.794

Table 4 Univariable and multivariable Cox regression analyses of recurrence-free survival in ampullary carcinoma patients

Characteristic	Univariable analysis		Multivariable analysis
	HR (95%CI)	P value	HR (95%CI)	P value
Perioperative Blood Transfusion
No	Reference		Reference
Yes	0.886 (0.607-1.293)	0.531	0.983 (0.667-1.447)	0.929
RBC units
0	Reference
1-4 units	0.854 (0.579-1.261)	0.428
≥ 5 units	1.282 (0.550-2.989)	0.565
Sex
Male	Reference
Female	0.976 (0.665-1.431)	0.9
Age (yr)
≤ 60	Reference		Reference
> 60	0.422 (0.282-0.631)	< 0.001	0.886 (0.407-1.928)	0.760
Operation time
≤ 6 h	Reference
> 6 h	1.194 (0.780-1.829)	0.414
Tumor size (cm)
≤ 2.0 cm	Reference		Reference
> 2.0 cm	1.458 (0.998-2.129)	0.051	1.121 (0.745-1.687)	0.583
Differentiation
Well	Reference		Reference
Moderate	0.892 (0.586-1.358)	0.594	1.100 (0.702-1.723)	0.679
Poor	0.511 (0.294-0.889)	0.018	0.970 (0.499-1.884)	0.928
T stage
T1	Reference		Reference
T2	1.451 (0.757-2.784)	0.262	1.239 (0.611-2.514)	0.553
T3	3.092 (1.656-5.773)	< 0.001	2.284 (0.874-4.968)	0.098
N stage
N0	Reference		Reference
N1	2.201 (1.449-3.343)	< 0.001	1.636 (0.932-2.873)	0.087
N2	3.248 (1.488-7.089)	0.003	2.441 (0.935-6.372)	0.068
Blood vessel invasion
No	Reference		Reference
Yes	2.351 (1.548-3.573)	< 0.001	1.744 (1.077-2.824)	0.024
Postoperative complications
No	Reference
Yes	0.959 (0.643-1.431)	0.839
Adjuvant treatment
No	Reference		Reference
Yes	1.501 (0.999-2.256)	0.051	0.711 (0.420-1.205)	0.205