Allogenic Blood Transfusion Is an Independent Predictor of Poorer Peri-operative Outcomes and Reduced Long-Term Survival After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Review of 936 Cases

J Gastrointest Surg. 2017 Aug;21(8):1318-1327. doi: 10.1007/s11605-017-3444-8. Epub 2017 May 30.

Abstract

Introduction: There is a paucity of data on the impact of allogenic blood transfusion (ABT) on morbidity and survival outcomes after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC).

Methods: Nine hundred and thirty-five consecutive CRS/HIPEC procedures were performed between 1996 and 2016 at a high-volume institution in Sydney, Australia. Of these, 337(36%) patients required massive ABT (MABT) (≥5 units). Peri-operative complications were graded according to the Clavien-Dindo classification. The association of concomitant MABT with 21 peri-operative outcomes and overall survival (OS) was assessed using univariate and multivariate analyses.

Results: In-hospital mortality was 1.8%. Patients requiring MABT had more extensive disease as reflected by a higher peritoneal cancer index (≥17) (70 vs. 29%, p < 0.001) and longer operative times (≥9 h) (82 vs. 35%, p < 0.001). After accounting for confounding factors, MABT was associated with in-hospital mortality (relative risk (RR), 7.72; 95% confidence interval (CI), 1.35-10.11; p = 0.021) and grade III/IV morbidity (RR, 2.05; 95% CI, 1.42-2.95; p < 0.001). MABT was associated with an increased incidence of prolonged hospital stay (≥28 days) (RR, 1.86; 95% CI, 1.26-2.74; p = 0.002) and intensive care unit stay (≥4 days) (RR, 1.83; 95% CI, 1.24-2.70, p = 0.002). It was also associated with a significant OS in patients with colorectal cancer peritoneal carcinomatosis (RR 4.49; p < 0.001) and pseudomyxoma peritonei (RR, 4.37; p = 0.026), but not appendiceal cancer (p = 0.160).

Conclusion: MABT is an independent predictor for poorer peri-operative outcomes including in-hospital mortality and grade III/IV morbidity. It may also compromise long-term survival, particularly in patients with colorectal cancer peritoneal carcinomatosis.

Keywords: Blood transfusion; Cytoreductive; Hyperthermic; Intraperitoneal; Morbidity; Mortality; Survival.

Publication types

  • Observational Study

MeSH terms

  • Abdominal Neoplasms / mortality
  • Abdominal Neoplasms / therapy*
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Australia
  • Chemotherapy, Cancer, Regional Perfusion*
  • Combined Modality Therapy
  • Cytoreduction Surgical Procedures*
  • Erythrocyte Transfusion / adverse effects*
  • Female
  • Follow-Up Studies
  • Hospital Mortality
  • Humans
  • Hyperthermia, Induced*
  • Male
  • Middle Aged
  • Operative Time
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology*
  • Retrospective Studies
  • Risk Factors
  • Survival Analysis
  • Treatment Outcome
  • Young Adult