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肝癌手术中输注浓缩红细胞：总生存受损的预测因素，但不是无复发生存的预测因素 - 肝外科中输血的影响。

Transfusions of packed red blood cells in surgery for liver cancer: predictor of impaired overall survival but not recurrence-free survival - impact of blood transfusions in liver surgery.

机构信息

Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases/University Cancer Center, Dresden, Germany; Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

Department of Visceral, Thoracic, and Vascular Surgery, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.

出版信息

J Gastrointest Surg. 2024 Apr;28(4):402-411. doi: 10.1016/j.gassur.2023.12.019. Epub 2024 Jan 23.

DOI:10.1016/j.gassur.2023.12.019

PMID:38583890

Abstract

BACKGROUND

Liver surgery remains a cornerstone of potentially curative multimodal treatments for primary malignancies of the liver and hepatic metastases. Improving perioperative safety is a prerequisite in this context. Perioperative blood transfusions negatively influence postoperative recovery. This study aimed to identify risk factors for perioperative packed red blood cell (PRBC) transfusion and to elucidate its effect on postoperative outcomes.

METHODS

This was an observational study of a prospective data collection. A monocentric, retrospective analysis of 1118 hepatectomies at the University Hospital Carl Gustav Carus between 2013 and 2020 was conducted to compare postoperative short- and long-term outcomes in patients undergoing curative intended liver resection of hepatic primary or secondary malignancies. The outcomes were compared between 356 patients (31.8%) who received PRBC transfusions during surgery or within 7 days after surgery and 762 patients (68.2%) who did not receive PRBC transfusions.

RESULTS

Preoperative anemia could be observed in 45.0% of the whole cohort: 65.7% in the PRBC transfusion group and 35.3% in the nontransfused group. Postoperative complications were significantly more common in the PRBC transfusion group in association with prolonged lengths of hospital stay and increased 30-day mortality than in the nontransfused group. After adjustment for possible confounders, preexisting kidney failure, preoperative hemoglobin and albumin levels outside of the reference range, intraoperative plasma transfusions, and overall surgery time were recognized as negative predictors for perioperative PRBC transfusions. PRBC transfusion increased the risk of death by approximately 38.8% (hazard ratio, 1.388; 95% CI, 1.027-1.876; P = .033), whereas no influence on recurrence-free survival (RFS) was observed.

CONCLUSION

PRBC transfusions were associated with postoperative morbidity and mortality after curative-intended surgery for liver cancers and represented an independent poor prognostic indicator for overall survival but not for RFS.

摘要

背景

肝脏手术仍然是原发性肝癌和肝转移瘤多模态治疗中潜在治愈方法的基石。改善围手术期安全性是这方面的前提。围手术期输血会对术后恢复产生负面影响。本研究旨在确定围手术期输红细胞（PRBC）的危险因素，并阐明其对术后结果的影响。

方法

这是一项前瞻性数据收集的观察性研究。对 2013 年至 2020 年期间卡尔古斯塔夫·卡鲁斯大学医院进行的 1118 例肝切除术的单中心回顾性分析，以比较接受根治性肝切除术治疗原发性或继发性肝恶性肿瘤的患者的术后短期和长期结果。将接受手术期间或手术后 7 天内 PRBC 输血的 356 例患者（31.8%）与未接受 PRBC 输血的 762 例患者（68.2%）的结果进行比较。

结果

整个队列中术前贫血的发生率为 45.0%：PRBC 输血组为 65.7%，未输血组为 35.3%。与未输血组相比，PRBC 输血组的术后并发症更为常见，与住院时间延长和 30 天死亡率增加相关。在调整可能的混杂因素后，术前肾衰竭、术前血红蛋白和白蛋白水平不在参考范围内、术中血浆输血和总手术时间被认为是围手术期 PRBC 输血的负面预测因素。PRBC 输血使死亡风险增加了约 38.8%（危险比，1.388；95%CI，1.027-1.876；P=0.033），但对无复发生存率（RFS）没有影响。