Bortul Marina, Calligaris Luca, Roseano Mauro, Leggeri Aldo
Surgical Science Department, Clinica Chirurgica Generale, University of Trieste, Italy.
Suppl Tumori. 2003 Sep-Oct;2(5):S27-30.
On the basis of an analysis of our experience and a review of the literature, this report discusses the effects of perioperative blood transfusions on postoperative morbidity, mortality and 5-year survival in a series of patients who underwent curative surgical treatment of gastric cancer. The authors analyze a consecutive series of 137 patients who underwent curative total or subtotal gastrectomy D2 or D3. Ninety-nine patients (72.2%) received perioperative transfusions. The data examined included the number and timing of transfusions (pre-, intra-, or postoperative), the type of operation (total or subtotal gastrectomy with or without splenectomy), tumor stage (pTNM), and the correlation between transfusions, mortality, morbidity and survival. Advanced T-stage (P = 0.01) and total gastrectomy (P = 0.009) were associated with a higher transfusion rate. No cases of operative mortality were recorded after 1988. Specific morbidity was 10.5% in non-transfused patients and 20.1% in transfused. Five-year survival rate in the transfused patients (28.3%) was significantly lower than in the non-transfused group (53.5%) (P = 0.03). Univariate analysis showed that T-stage (P = 0.001) and N-stage (P = 0.04) were associated with a lower survival. By multivariate analysis (Cox regression model) only T-stage (P = 0.001) and N-stage (P = 0.04) were independent prognostic factors, whereas transfusions were not an independent variable (P = 0.27). To conclude, the issue of the real impact of transfusions on the prognosis of gastric cancer is far from being settled, although the T and N parameters are known to be strictly correlated to prognosis. This study further confirms the importance of limiting homologous transfusions as well as of transfusing, whenever possible, autologous or leukodepleted blood; this, however, without losing sight of the primary goal of minimizing operative blood loss.
在分析我们的经验并回顾相关文献的基础上，本报告探讨了围手术期输血对一系列接受胃癌根治性手术治疗患者术后发病率、死亡率和5年生存率的影响。作者分析了连续137例行根治性全胃或次全胃切除术（D2或D3）的患者。99例患者（72.2%）接受了围手术期输血。所检查的数据包括输血的次数和时间（术前、术中或术后）、手术类型（全胃或次全胃切除术，有无脾切除术）、肿瘤分期（pTNM）以及输血与死亡率、发病率和生存率之间的相关性。T分期较晚（P = 0.01）和全胃切除术（P = 0.009）与较高的输血率相关。1988年后未记录到手术死亡病例。未输血患者的特定发病率为10.5%，输血患者为20.1%。输血患者的5年生存率（28.3%）显著低于未输血组（53.5%）（P = 0.03）。单因素分析显示，T分期（P = 0.001）和N分期（P = 0.04）与较低的生存率相关。通过多因素分析（Cox回归模型），只有T分期（P = 0.001）和N分期（P = 0.04）是独立的预后因素，而输血不是一个独立变量（P = 0.27）。总之，尽管已知T和N参数与预后密切相关，但输血对胃癌预后的实际影响问题远未解决。本研究进一步证实了限制同源输血以及尽可能输注自体血或去白细胞血的重要性；然而，在这一过程中不能忽视尽量减少手术失血这一主要目标。
