Original article

Blood Transfusion - 2 2022 (March-April)

Effect of peri-operative blood transfusions on long-term prognosis of patients with colorectal cancer

Authors

Key words: colorectal cancer, anaemia, blood transfusion, red blood cells, surgery
Publication Date: 2020-12-22

Abstract

Background - Patients with colorectal cancer often present with anaemia and require red blood cell transfusions (RBCT) during their peri-operative course. Evidence suggests a significant association between RBCT and poor long-term outcomes in surgical patients, but the findings in colorectal cancer are contradictory.
Material and methods - The aim of this retrospective, single-centre, cohort study was to investigate the prognostic role of peri-operative RBCT in a large cohort of patients with stage I-III colorectal cancer submitted to curative surgery between 2005 and 2017. The propensity score matching technique was applied to adjust for potential confounding factors.
Results - Among 1,414 patients operated within the study period, 895 fulfilled the inclusion criteria: 29.6% (n=265) received peri-operative RBCT. The group that received peri-operative RBCT was significantly older (p<0.001), had more comorbidities (p<0.001), more advanced tumours (p<0.001) and more colon tumours (p=0.002) and stayed in hospital longer (p<0.001). Post-operative mortality was 7-fold higher (2.3 vs 0.3%, p=0.01) in this group. Survival outcomes were significantly worse in the group receiving RBCT than in the group not receiving RBCT for both overall (64.5 vs 80.1%, p<0.001) and cancer-specific survival (74.3 vs 85.1%, p<0.001). On multivariable analysis, peri-operative RBCT was significantly associated with poorer overall survival (hazard ratio 1.51, p=0.009). When transfused and non-transfused cases were paired through the propensity score matching technique considering main clinico-pathological features, no differences in overall and cancer-specific survival were found.
Discussion - Our data suggest that, after adjustment for potential confounding factors, no significant association exists between RBCT and prognosis in colorectal cancer.

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Authors

Giulia Turri - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

Corrado Pedrazzani - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

Giovanni Malerba - Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy

Gabriele Gecchele - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

Cristian Conti - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

Andrea Ruzzenente - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

Giuseppe Lippi - 3Department of Neurological, Biomedical and Movement Sciences, Section of Clinical Biochemistry, University of Verona, Verona, Italy

Federica Randon - Department of Transfusion Medicine, Verona University Hospital, Verona, Italy

Pierluigi Piccoli - Department of Transfusion Medicine, Verona University Hospital, Verona, Italy

Giorgio Gandini - Department of Transfusion Medicine, Verona University Hospital, Verona, Italy

Domenico Girelli - Department of Medicine, Section of Internal Medicine, University of Verona, Verona, Italy

Alfredo Guglielmi - Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Unit of General and Hepatobiliary Surgery, University of Verona, Verona, Italy

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