术中出血量对 II/III 期结直肠癌患者生存的影响：一项多中心回顾性研究。
Impact of Intraoperative Blood Loss on the Survival of Patients With Stage II/III Colorectal Cancer: A Multicenter Retrospective Study.
机构信息
Department of Surgery, Yokohama City University, Yokohama, Japan;
Department of Surgery, Yokohama City University, Yokohama, Japan.
出版信息
In Vivo. 2021 Nov-Dec;35(6):3483-3488. doi: 10.21873/invivo.12649.
BACKGROUND
Resection of the primary lesion with radical lymph node dissection is the most promising treatment avenue for patients with cancer. On the other hand, these procedures often induce excessive intraoperative blood loss (IBL) and require perioperative blood transfusion. The influence of IBL on the long-term postoperative outcomes of patients with digestive cancer is controversial. We investigated the impact of IBL on survival and recurrence after curative surgery in patients with colorectal cancer (CRC) in a single study group.
PATIENTS AND METHODS
In total, 1,597 patients who underwent radical resection for CRC at three group hospitals between 2000 and 2019 were reviewed. Patients were classified into a group with high IBL (≥200 ml) or low IBL (<200 ml). The risk factors for disease-free (DFS) and overall (OS) survival were analyzed.
RESULTS
A total of 489 and 1,108 patients were classified into the high and low IBL groups, respectively. The OS and DFS rates at 5 years after surgery were 89.3% and 63.4%, respectively, for the high IBL group and 96.9% and 77.8% for the low IBL group; these differences were statistically significantly (p<0.001). The multivariate analysis demonstrated that IBL was a significant independent risk factor for OS and DFS.
CONCLUSION
The amount of IBL was associated with significant differences in the OS and DFS of patients with stage II/III CRC who received curative resection. The surgical procedure, surgical strategy, and perioperative care should be carefully planned to avoid causing IBL.
背景
对于癌症患者，切除原发病灶并进行根治性淋巴结清扫是最有希望的治疗方法。另一方面，这些手术通常会导致术中失血过多（IBL），需要围手术期输血。IBL 对消化道癌症患者长期术后结局的影响存在争议。我们在一个单一的研究组中研究了 IBL 对结直肠癌（CRC）患者根治性手术后生存和复发的影响。
患者和方法
共回顾了 2000 年至 2019 年期间在三家医院接受根治性 CRC 切除术的 1597 例患者。患者被分为 IBL 高（≥200ml）或 IBL 低（<200ml）组。分析了无病（DFS）和总（OS）生存的危险因素。
结果
共有 489 例和 1108 例患者分别被归入 IBL 高和 IBL 低组。术后 5 年 OS 和 DFS 率分别为 IBL 高组的 89.3%和 63.4%，IBL 低组的 96.9%和 77.8%；这些差异具有统计学意义（p<0.001）。多因素分析表明，IBL 是 OS 和 DFS 的独立危险因素。
结论
在接受根治性切除术的 II/III 期 CRC 患者中，IBL 量与 OS 和 DFS 存在显著差异。应仔细计划手术过程、手术策略和围手术期护理，以避免发生 IBL。
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