Ristescu Irina, Pintilie Georgiana, Filip Diana, Jitca Mirel, Fecheta Rafaela, Florescu Ioana, Scripcariu Viorel, Filipescu Daniela, Grigoraş Ioana
Chirurgia (Bucur). 2019 Mar-Apr;114(2):234-242. doi: 10.21614/chirurgia.114.2.234.
Both anemia and blood transfusion are now considered independent risk factors for poor outcome in colorectal cancer patients. Severe anemia can increase tumor aggressiveness and blood transfusion may induce immunosuppression and promote cancer recurrence. Specific Patient Blood Management (PBM) strategies for oncological surgical patients are insufficiently defined and recommended. Primary objectives: Evaluation of the perioperative anemia prevalence and transfusion rate in colorectal cancer patients. Secondary objectives: Sub-group analysis of anemic versus non-anemic patients and colon versus rectal cancer patients. We retrospectively reviewed records from all consecutive surgical oncological patients admitted between January and June 2017. We selected major lower abdominal surgical patients and then colorectal surgical patients. We evaluated the perioperative hemoglobin values dynamics (preoperative=Hb1, postoperative= Hb2, at discharge= Hb3), anemia prevalence and severity and transfusion rate. Statistical analysis used Student t test, Wilcoxon signed-rank and Chi-square tests from SPSS 17. Of the 1284 patients screened, 546 patients were submitted to major lower abdominal surgery and 260 patients to colorectal cancer surgery. The mean age was 65.6 +- 11.1 years, 57.7% males. The perioperative dynamics of hemoglobin was Hb1/Hb2/Hb3 =12/10.6/10.4 g/dL. Anemia prevalence was 52.3/82.3/82.6% preoperatively/postoperatively/at hospital discharge. Global transfusion rate was 23.8%, with pre/intra/postoperative distribution of 2.3/11.9/10.8%. Anemic patients were older (p=0.005), with a higher transfusion rate (p 0.001) and a longer hospital LOS (p=0.04). Colon cancer patients had lower Hb values (p=0.001) and higher prevalence of preoperative anemia (p=0.001) comparing with rectal cancer patients. The analysis of this cohort of colorectal cancer patients identified an increased prevalence of anemia in all perioperative phases. There is an urgent need of PBM program implementation in this selected group of surgical patients.
贫血和输血现在都被认为是结直肠癌患者预后不良的独立危险因素。严重贫血会增加肿瘤侵袭性，而输血可能会导致免疫抑制并促进癌症复发。针对肿瘤外科手术患者的特定患者血液管理（PBM）策略尚未得到充分定义和推荐。主要目标：评估结直肠癌患者围手术期贫血患病率和输血率。次要目标：对贫血患者与非贫血患者以及结肠癌患者与直肠癌患者进行亚组分析。我们回顾性分析了2017年1月至6月期间所有连续入院的外科肿瘤患者的记录。我们先筛选出下腹部大手术患者，然后是结直肠手术患者。我们评估了围手术期血红蛋白值动态变化（术前=Hb1，术后=Hb2，出院时=Hb3）、贫血患病率和严重程度以及输血率。统计分析采用SPSS 17中的学生t检验、Wilcoxon符号秩检验和卡方检验。在筛选的1284例患者中，546例接受了下腹部大手术，260例接受了结肠癌手术。平均年龄为65.6±11.1岁，男性占57.7%。血红蛋白的围手术期动态变化为Hb1/Hb2/Hb3 =12/10.6/10.4 g/dL。术前/术后/出院时贫血患病率分别为52.3%/82.3%/82.6%。总体输血率为23.8%，术前/术中/术后分布分别为2.3%/11.9%/10.8%。贫血患者年龄较大（p=0.005），输血率较高（p<0.001），住院时间较长（p=0.04）。与直肠癌患者相比，结肠癌患者血红蛋白值较低（p=0.001），术前贫血患病率较高（p=0.001）。对这组结直肠癌患者的分析发现，围手术期各阶段贫血患病率均有所增加。在这组选定的手术患者中迫切需要实施PBM计划。
