Kamei Takao, Kitayama Joji, Yamashita Hiroharu, Nagawa Hirokazu
Department of Surgery, Division of Surgical Oncology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
World J Surg. 2009 Jun;33(6):1240-6. doi: 10.1007/s00268-009-9979-4.
Perioperative blood transfusion has been shown to be associated with poor outcome in various types of malignancy. However, the relationship between the amount of blood loss and specific types of cancer recurrence has not been documented.
We retrospectively examined the amount of intraoperative blood loss and the recurrence pattern in 146 patients who underwent curative gastrectomy for advanced gastric cancer and assessed the possible correlation between intraoperative blood loss and peritoneal, locoregional, and hematogenous recurrences.
The amount of intraoperative blood loss in patients who developed peritoneal recurrence was significantly greater than that in patients without peritoneal recurrence, irrespective of blood transfusion. In contrast, the blood loss was not associated with nodal or hematogenous recurrence. Multivariate analysis demonstrated that large blood loss as well as operative curability B and adjuvant chemotherapy were independent risk factors for peritoneal recurrence and a worse outcome in advanced gastric cancer.
Intraoperative blood loss in curative gastrectomy for advanced gastric cancer may have a specific association with the development of peritoneal recurrence. Surgeons must remember that clean and dry surgery may lessen not only 30-day mortality and morbidity but long-term peritoneal recurrence in gastric cancer.
围手术期输血已被证明与各种类型恶性肿瘤的不良预后相关。然而，失血量与特定类型癌症复发之间的关系尚未见文献报道。
我们回顾性研究了146例行根治性胃癌切除术的进展期胃癌患者的术中失血量及复发模式，并评估了术中失血量与腹膜、局部区域和血行转移复发之间的可能相关性。
发生腹膜复发患者的术中失血量显著大于未发生腹膜复发的患者，与是否输血无关。相比之下，失血量与淋巴结转移或血行转移复发无关。多因素分析表明，大量失血以及手术根治性B级和辅助化疗是进展期胃癌腹膜复发和不良预后的独立危险因素。
进展期胃癌根治性胃切除术中的术中失血可能与腹膜复发的发生有特定关联。外科医生必须牢记，清洁无血的手术不仅可以降低30天死亡率和发病率，还可以减少胃癌的长期腹膜复发。
