resection, a surgical procedure that removes cancer and a margin of healthy
tissue that surrounds it is used to treat patients with early-stage liver
cancer, having a normal liver function.
Despite advances made in liver surgery that have helped reduce the surgical
blood loss considerably, liver resection is associated with the risk of
excessive blood loss and requirement of blood transfusion.
on cancer outcomes has never
been understood completely. Research on this subject has reported conflicting
findings for decades now. It has not been possible to arrive upon a conclusion
if the problems are caused by blood transfusion alone.
was a noticeable increase in risk even when a
small amount of blood was transfused, the researchers of the study have
reported. The study findings have shown
that cancer recurrence risk increased by 23 percent and death by 55 percent
following transfusion of 1 to 4 units of blood, when compared to matched
Ying-Hsuan Tai from Taipei Medical University Shuang Ho Hospital in Taiwan, the
study's lead researcher remarked, "Our
findings from a large cohort highlighted a significant association between red
blood cell transfusions and the risk of cancer recurrence as well as a
dose-response relationship between the amount of transfusions and death after
curative surgery for liver cancer. The reason why blood transfusions
substantially worsen cancer prognosis remains unclear, but it is likely to be
related to the suppressive effects on the immune system,"
Study Design and
effect of perioperative blood transfusion on cancer prognosis in 1,469 patients
who had undergone HCC resection surgery at Taipei Veterans General Hospital,
Taipei, Taiwan between 2005 and 2016 was studied by Dr. Tai and his team. There
was no lymph node involvement or metastasis in these patients. Postoperative
disease-free survival and overall survival up to September 2018 were assessed
by the team.
comparing patient outcomes, inverse probability of treatment weighting, a
statistical modeling technique was used to match patients who had equivalent
age and health conditions.
to 4 units of allogeneic blood were given to 1 in 3 patients (30 percent; 447
patients), during or within 7 days of surgery, while more than 4 units were
given to more than 1 in 10 patients (12 percent; 179 patients). In a median 45
month follow-up, investigations showed that there was a 23 percent chance of cancer recurrence in patients who received a
transfusion (1-4 units) as compared to those who did not. Similarly, patients who
received more than 4 units were faced with an 18 percent greater risk of
recurrence when compared to those who did not receive any.
Patients who received
1-4 units of blood were 55 percent more likely to die from any cause in
comparison to those who did not receive a transfusion. Those who received 4 or
more units had almost double the risk of death.The authors of the study concluded, "These data highlight
the need for randomized trials to evaluate the influence of transfusion on cancer outcome
and identify the level anemia that
patients undergoing liver cancer surgery can withstand (or the minimum amount
of blood they need to have transfused) with minimal adverse effects in order to
guide practice. Until these trials have been completed, surgeons should use
practices that reduce the risk of bleeding and the need for transfusion."
findings of the study will be presented at the Euro-anaesthesia Congress, the
annual meeting of the European Society of Anaesthesiology to be held this year
at Vienna, Austria.
- European Society of Anaesthesiology - (https://www.esahq.org/)