Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, United States.
J Gastrointest Surg. 2024 Jun;28(6):852-859. doi: 10.1016/j.gassur.2024.03.014. Epub 2024 Mar 13.
The effect of preoperative anemia on clinical outcomes of patients undergoing resection of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) has not been previously investigated. This study aimed to characterize how preoperative anemia affected short- and long-term outcomes of patients undergoing curative-intent resection of GEP-NETs.
Patients who underwent curative-intent resection for GEP-NETs between January 1990 and December 2020 were identified from 8 major institutions. The last preoperative hemoglobin level was recorded; anemia was defined as <13.5 g/dL in males or <12.0 g/dL in females based on the guides of the American Society of Hematology. The effect of anemia on postoperative outcomes was assessed on uni- and multivariate analyses.
Among 1559 patients, the median age was 58 years (IQR, 48-66), and roughly one-half of the cohort was male (796 [51.1%]). Most patients had a pancreatic tumor (1040 [66.7%]), followed by small bowel (259 [16.6%]), duodenum (103 [6.6%]), stomach (66 [4.2%]), appendix (53 [3.4%]), and other locations (38 [2.6%]). The median preoperative hemoglobin level was 13.4 g/dL (IQR, 12.2-14.5). Overall, 101 (6.7%) and 119 (8.5%) patients received an intra- or postoperative packed red blood cell (pRBC) transfusion, respectively. A total of 972 patients (44.5%) experienced a postoperative complication. Although the overall incidence of complications was no different among patients who did (anemic: 48.7%) vs patients who did not (nonanemic: 47.3%) have anemia (P = .597), patients with preoperative anemia were more likely to develop a major (Clavien-Dindo grade ≥IIIa: 48.9% [anemic] vs 38.0% [nonanemic]; P = .006) and multiple (≥3 types of complications: 32.2% [anemic] vs 19.7% [anemic]; P < .001) complications. Of note, 1-, 3-, and 5-year overall survival (OS) rates were 96.7%, 90.5%, and 86.6%, respectively. On multivariable analysis, anemia (hazard ratio, 2.0; 95% CI, 1.2-3.2; P = .006) remained associated with worse OS; postoperative pRBC transfusion was associated with an OS (5-year OS: 75.0% vs 87.7%; P = .017) and recurrence-free survival (RFS; 5-year RFS: 66.9% vs 76.5%; P = .047).
Preoperative anemia was commonly identified in roughly 1 in 3 patients who underwent curative-intent resection for GEP-NETs. Preoperative anemia was strongly associated with a higher risk of postoperative morbidity and worse long-term outcomes.
术前贫血对接受胃肠胰神经内分泌肿瘤（GEP-NETs）切除术患者的临床结局的影响尚未得到研究。本研究旨在描述术前贫血如何影响接受根治性切除的 GEP-NETs 患者的短期和长期结局。
从 8 家主要机构中确定了 1990 年 1 月至 2020 年 12 月期间接受根治性切除治疗的 GEP-NETs 患者。记录最后一次术前血红蛋白水平；根据美国血液学会指南，男性<13.5 g/dL 或女性<12.0 g/dL 定义为贫血。使用单变量和多变量分析评估贫血对术后结局的影响。
在 1559 名患者中，中位年龄为 58 岁（IQR，48-66），约一半的患者为男性（796 [51.1%]）。大多数患者有胰腺肿瘤（1040 [66.7%]），其次是小肠（259 [16.6%]）、十二指肠（103 [6.6%]）、胃（66 [4.2%]）、阑尾（53 [3.4%]）和其他部位（38 [2.6%]）。中位术前血红蛋白水平为 13.4 g/dL（IQR，12.2-14.5）。总体而言，101 名（6.7%）和 119 名（8.5%）患者分别接受了术中或术后输血。共有 972 名（44.5%）患者发生术后并发症。尽管贫血患者（贫血：48.7%）和非贫血患者（非贫血：47.3%）的总体并发症发生率无差异（P =.597），但术前贫血患者更有可能发生严重（Clavien-Dindo 分级≥IIIa：48.9%[贫血] vs 38.0%[非贫血]；P =.006）和多种（≥3 种并发症：32.2%[贫血] vs 19.7%[非贫血]；P <.001）并发症。值得注意的是，1、3 和 5 年的总生存率（OS）分别为 96.7%、90.5%和 86.6%。多变量分析显示，贫血（风险比，2.0；95%CI，1.2-3.2；P =.006）与较差的 OS 仍然相关；术后输血与 OS（5 年 OS：75.0% vs 87.7%；P =.017）和无复发生存率（RFS；5 年 RFS：66.9% vs 76.5%；P =.047）相关。
术前贫血在接受 GEP-NETs 根治性切除术的患者中约每 3 人中就有 1 人被发现。术前贫血与术后发病率升高和长期结局较差强烈相关。
