Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan.
World J Gastroenterol. 2019 Jun 14;25(22):2743-2751. doi: 10.3748/wjg.v25.i22.2743.
Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients' prognosis.
胃切除术联合根治性淋巴结清扫术是治疗胃癌患者最有前途的治疗方法。然而，该手术有时会导致术中过度失血，并需要围手术期异体输血。对于术中失血或围手术期输血是否会对胃癌患者的预后产生不良影响，一直存在着讨论和争议。我们回顾了与胃癌患者相关的这些关联的实验室和临床证据。大量的临床证据支持术中过度失血与预后不良之间的相关性。实验室证据揭示了这种不良影响的三个可能原因：抗肿瘤免疫抑制、术后不利条件和癌细胞通过溢出进入骨盆引起的腹膜复发。几项系统评价和荟萃分析表明，围手术期输血对总死亡率、复发和术后并发症等预后参数有不良影响。输血对预后的不良影响有两个可能的原因：抗肿瘤免疫抑制和患者相关的混杂因素（如术前贫血）。这些因素与预后较差和对围手术期输血的需求较高有关。外科医生应努力减少胃癌手术中的术中失血和输血，以改善患者的预后。
