Department of Surgical Oncology, First Affiliated Hospital of China Medical University, No. 155 Nanjing North Street, Heping District, Shenyang, 110001, People's Republic of China.
Department of Clinical Medicine, Liaoning University of Traditional Chinese Medicine, No. 72 Chongshan East Street, Huanggu District, Shenyang, 110032, People's Republic of China.
Clin Transl Oncol. 2019 Sep;21(9):1197-1206. doi: 10.1007/s12094-019-02046-6. Epub 2019 Jan 28.
Whether intraoperative blood loss (IBL) was independently associated with poor prognosis of gastric cancer (GC) patients remains controversial. In the present study, we evaluated the impact of IBL on the disease-free survival (DFS) of GC patients.
A total of 1669 patients who underwent curative gastrectomy for GC were reviewed retrospectively. All patients were classified as IBL < 400 mL and IBL ≥ 400 mL group according to the amount of IBL. The prognostic difference between two patient groups was compared and clinicopathologic factors associated with the prognosis of GC patients were analyzed.
The 5-year DFS rate of the patients with IBL < 400 mL and those with IBL ≥ 400 mL was 52.1% and 41.5%, respectively (P < 0.001). The 5-year DFS rate of the patients who did and did not receive intraoperative blood transfusion was 36.9% and 53.2%, respectively (P < 0.001). However, the similar survival outcomes were not observed in the subgroup analysis based on the TNM stage. The multivariate analysis indicated that IBL (HR 1.021, 95% CI 0.875-1.191, P > 0.05) and intraoperative blood transfusion (HR 1.111, 95% CI 0.943-1.309, P > 0.05) were not independent prognostic factors for GC patients. In addition, the patients with IBL ≥ 400 mL had a higher risk of postoperative complications than those with IBL < 400 mL, especially for intraabdominal infection and wound infection. The tumor located in upper 1/3 stomach, total gastrectomy, combined organ resection and advanced tumor stage (stage III) were independent risk factors for intraoperative massive hemorrhage.
Intraoperative blood loss was significantly associated with tumor-related and surgery-related factors. Intraoperative blood loss itself could not independently affect survival outcome of GC patients after curative gastrectomy.
术中出血量（IBL）是否与胃癌（GC）患者的预后不良独立相关仍存在争议。本研究评估了 IBL 对 GC 患者无病生存（DFS）的影响。
回顾性分析了 1669 例接受 GC 根治性胃切除术的患者。根据 IBL 量，所有患者分为 IBL<400ml 和 IBL≥400ml 两组。比较两组患者的预后差异，并分析与 GC 患者预后相关的临床病理因素。
IBL<400ml 患者的 5 年 DFS 率为 52.1%，IBL≥400ml 患者的 5 年 DFS 率为 41.5%（P<0.001）。接受术中输血和未接受术中输血的患者的 5 年 DFS 率分别为 36.9%和 53.2%（P<0.001）。然而，在基于 TNM 分期的亚组分析中，未观察到相似的生存结果。多因素分析表明，IBL（HR 1.021，95%CI 0.875-1.191，P>0.05）和术中输血（HR 1.111，95%CI 0.943-1.309，P>0.05）不是 GC 患者的独立预后因素。此外，IBL≥400ml 的患者术后并发症风险高于 IBL<400ml 的患者，尤其是腹腔内感染和伤口感染。肿瘤位于上 1/3 胃、全胃切除术、联合器官切除术和晚期肿瘤分期（III 期）是术中大出血的独立危险因素。
术中出血量与肿瘤相关因素和手术相关因素显著相关。术中出血量本身不能独立影响 GC 患者根治性胃切除术后的生存结局。
