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Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy

 Ho Kyoung Hwang  ;  Myung Jae Jung  ;  Sung Hwan Lee  ;  Chang Moo Kang  ;  Woo Jung Lee 
 Journal of Hepato-Biliary-Pancreatic Sciences, Vol.23(8) : 497-507, 2016 
Journal Title
 Journal of Hepato-Biliary-Pancreatic Sciences 
Issue Date
Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/surgery ; Adult ; Aged ; Analysis of Variance ; Blood Transfusion/methods ; Blood Transfusion/standards ; Carcinoma, Pancreatic Ductal/mortality* ; Carcinoma, Pancreatic Ductal/pathology ; Carcinoma, Pancreatic Ductal/surgery* ; Cohort Studies ; Disease-Free Survival ; Female ; Follow-Up Studies ; Health Policy ; Humans ; Intraoperative Care/methods ; Male ; Middle Aged ; Multivariate Analysis ; Needs Assessment ; Neoplasm Invasiveness/pathology ; Neoplasm Staging ; Pancreatectomy/methods* ; Pancreatectomy/mortality ; Pancreatic Neoplasms/mortality* ; Pancreatic Neoplasms/pathology ; Pancreatic Neoplasms/surgery* ; ROC Curve ; Retrospective Studies ; Risk Assessment ; Survival Analysis ; Time Factors ; Transfusion Reaction* ; Treatment Outcome
Pancreatectomy ; Pancreatic cancer ; Survival ; Transfusion
BACKGROUND: The aim of the present study was to investigate the prognostic impact of transfusion following distal pancreatectomy (DP) for left-sided pancreatic ductal adenocarcinoma (PDAC). METHODS: Retrospective analysis was performed to identify prognostic factors in patients who underwent DP from July 1992 to October 2012. RESULTS: Forty-eight patients were male, and 35 were female with a mean age of 62 ± 9 years. Twenty-three (27.7%) of the patients received intraoperative blood transfusion. In univariate analysis, combined organ resection (P = 0.046), intraoperative transfusion (P?<?0.001), pathologic tumor size (≥3?cm, P = 0.051), clinical tumor size (≥3?cm, P = 0.008), lymph node metastasis (P = 0.021), lymph node ratio (LNR?≥?0.017, P?<?0.001), and tumor differentiation (P = 0.013) were analyzed to predict tumor recurrence. Multivariate analysis showed that lymph node metastasis (Exp(β) = 2.136, P = 0.016), LNR (Exp(β) = 2.003, P = 0.049), and intraoperative transfusion (Exp(β) = 2.793, P = 0.001) were independent prognostic factor predicting tumor recurrence. The amount of estimated blood loss was closely associated with intraoperative transfusion (P < 0.001). CONCLUSION: Intraoperative transfusion should be avoided by gentle operative handling to minimize intraoperative bleeding, and the appropriate transfusion policy should be followed to increase the survival outcome.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Lee, Sung Hwan(이성환)
Lee, Woo Jung(이우정) ORCID logo https://orcid.org/0000-0001-9273-261X
Jung, Myung Jae(정명재)
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
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