Sutton Jeffrey M, Kooby David A, Wilson Gregory C, Squires M Hart, Hanseman Dennis J, Maithel Shishir K, Bentrem David J, Weber Sharon M, Cho Clifford S, Winslow Emily R, Scoggins Charles R, Martin Robert C G, Kim Hong Jin, Baker Justin J, Merchant Nipun B, Parikh Alexander A, Abbott Daniel E, Edwards Michael J, Ahmad Syed A
Division of Surgical Oncology, Department of Surgery, University of Cincinnati College of Medicine, 234 Goodman Street, ML 0772, Cincinnati, OH, 45219, USA.
J Gastrointest Surg. 2014 Sep;18(9):1575-87. doi: 10.1007/s11605-014-2567-4. Epub 2014 Jun 19.
In this multi-institutional study of patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma, we sought to identify factors associated with perioperative transfusion requirement as well as the association between blood transfusion and perioperative and oncologic outcomes.
The surgical databases across six high-volume institutions were analyzed to identify patients who underwent pancreaticoduodenectomy for pancreatic adenocarcinoma from 2005 to 2010. For statistical analyses, patients were then stratified by transfusion volume according to whether they received 0, 1-2, or >2 units of packed red blood cells.
Among 697 patients identified, 42 % required blood transfusion. Twenty-three percent received 1-2 units, and 19 % received >2 units. Factors associated with an increased transfusion requirement included older age, heart disease, diabetes, longer operative time, higher blood loss, tumor size, and non-R0 margin status (all p < 0.05). The median disease-free survival (13.8 vs. 18.3 months, p = 0.02) and overall survival (14.0 vs. 21.0 months, p < 0.0001) durations of transfused patients were shorter than those of transfusion-free patients. Multivariate modeling identified intraoperative transfusion of >2 units (hazard ratio, 1.92, p = 0.009) and postoperative transfusions as independent factors associated with decreased disease-free survival.
This multi-institutional study represents the largest series to date analyzing the effects of perioperative blood transfusion on patient outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma. While blood transfusion was not associated with increased rate of infectious complications, allogeneic blood transfusion did confer a negative impact on disease-free and overall survival.
在这项针对因胰腺腺癌接受胰十二指肠切除术患者的多机构研究中，我们试图确定与围手术期输血需求相关的因素，以及输血与围手术期和肿瘤学结局之间的关联。
分析了六个高容量机构的手术数据库，以确定2005年至2010年因胰腺腺癌接受胰十二指肠切除术的患者。为进行统计分析，随后根据患者接受的浓缩红细胞单位数是否为0、1 - 2或>2，按输血量对患者进行分层。
在697例确诊患者中，42%需要输血。23%接受1 - 2单位输血，19%接受>2单位输血。与输血需求增加相关的因素包括年龄较大、心脏病、糖尿病、手术时间较长、失血量较多、肿瘤大小以及非R0切缘状态（所有p < 0.05）。输血患者的无病生存期（13.8个月对18.3个月，p = 0.02）和总生存期（14.0个月对21.0个月，p < 0.0001）的中位数短于未输血患者。多变量建模确定术中输血>2单位（风险比，1.92，p = 0.009）和术后输血是与无病生存期降低相关的独立因素。
这项多机构研究是迄今为止分析围手术期输血对胰腺腺癌胰十二指肠切除术后患者结局影响的最大系列研究。虽然输血与感染并发症发生率增加无关，但异体输血确实对无病生存期和总生存期产生负面影响。
