Annals of Surgical Oncology



Perioperative Blood Transfusion and the Prognosis of Pancreatic Cancer Surgery: Systematic Review and Meta-analysis

• Michael N. Mavros

• Li Xu

• Hadia Maqsood

• Faiz Gani

• Aslam Ejaz

• Gaya Spolverato

• Waddah B. Al-Refaie

• Steven M. Frank

• Timothy M. Pawlik Email author

Mavros MN1,2,3, Xu L2,4,5, Maqsood H2, Gani F2, Ejaz A6, Spolverato G2, Al-Refaie WB7, Frank SM8, Pawlik TM9.

1. Department of Surgery, MedStar Washington Hospital Center, Washington, DC, USA.

2. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

3. Alfa Institute of Biomedical Sciences, Marousi, Athens, Greece.

4. Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China.

5. State Key Laboratory of Oncology in Southern China, Guangzhou, China.

6. Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA.

7. Department of Surgery, MedStar Georgetown University Hospital Center, Washington, DC, USA.

8. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

9. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. tpa

Annals of Surgical Oncology

December 2015, Volume 22, Issue 13, pp 4382–4391



First Online: 21 August 2015

Received: 01 June 2015

DOI: 10.1245/s10434-015-4823-6

Cite this article as: Mavros, M.N., Xu, L., Maqsood, H. et al. Ann Surg Oncol (2015) 22: 4382.

Takeaway

• A meta-analysis revealed that pancreatic cancer patients who received perioperative blood transfusions (PBT) before curative surgery had significantly lower five-year survival compared with those who did not.

Study design

• A systematic review and meta-analysis was performed on 3,646 pancreatic cancer patients from 19 studies who underwent curative surgery to determine associations between PBT and five-year overall survival.

Key results

• 13/19 studies reported a detrimental effect of PBT on survival by univariable analysis.

• 9/19 studies reported a detrimental effect of PBT on survival by multivariable analysis.

• Overall, PBT was associated with shorter overall survival (pooled odds ratio 2.43, 95% confidence interval 1.90-3.10).

Abstract

Background

Perioperative blood transfusion (PBT) is common in pancreatic surgery. Recent studies have suggested that PBT may be associated with worse long-term outcomes.

Methods

A systematic review and meta-analysis of studies comparing long-term clinical outcomes of cancer patients undergoing curative-intent pancreatic surgery with regard to occurrence of PBT was performed.

Results

A total of 23 studies (4339 patients) were included in the systematic review, and 19 studies (3646 patients) were included in the meta-analysis. Nearly half (45.8 %) of all patients were female (range 25–60 %), and median age ranged from 59 to 72 years. About half (46.5 %, range 19–72 %) of the patients were transfused. Most had pancreatic ductal adenocarcinoma (69.5 %), while others had ampullary carcinoma (15.0 %), cholangiocarcinoma (7.4 %), or exocrine tumors of pancreas (8.1 %). Most (91.1 %) underwent pancreaticoduodenectomy, while the remaining patients underwent a total or distal pancreatectomy. The 5-year overall survival for all patients ranged from 0 to 65 %. Thirteen and nine of 19 studies reported a detrimental effect of PBT on survival on univariable and multivariable analysis, respectively. Overall, PBT was associated with shorter overall survival (pooled odds ratio 2.43, 95 % confidence interval 1.90–3.10); this finding was reproduced in sensitivity analysis.

Conclusions

Patients receiving PBT had significantly lower 5-year survival after curative-intent pancreatic surgery. Further research should focus on implementing guidelines for and discerning factors associated with the poor outcomes after PBT.

Michael N. Mavros and Li Xu have contributed equally to this project.

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