caa a22 4500 445336986 CHVBK 20180317142759.0 cr unu---uuuuu 170323e20110501xx s 000 0 eng 10.1245/s10434-010-1476-3 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1476-3 Effects of Perioperative Red Blood Cell Transfusion on Disease Recurrence and Survival After Pancreaticoduodenectomy for Ductal Adenocarcinoma [Elektronische Daten] [Peter Kneuertz, Sameer Patel, Carrie Chu, Shishir Maithel, Juan Sarmiento, Keith Delman, Charles Staley III, David Kooby] Background: The premise that allogeneic red blood cell transfusion (RBCT) contributes to adverse oncologic outcomes after surgery remains controversial. We examined the effects of RBCT during and after pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) on disease recurrence and survival. Methods: A prospective database of 220 patients undergoing PD for PDAC from 2000 to 2008 was reviewed and transfusion data collected. Univariate and multivariate analyses were performed for factors influencing RBCT, recurrence-free survival (RFS), and overall survival (OS). The effect of amount and timing (intraoperative vs. postoperative) of RBCT was analyzed. Results: One hundred forty-seven patients (67%) received RBCT: 70 (32%) received 1 to 2 units, and 77 (35%) received >2 units. Median RFS and OS for the entire cohort was 12 and 16months, respectively. RBCT of >2 units was associated with reduced RFS (9 vs. 15months; P=0.033) and OS (14 vs. 20months; P=0.003). Stratified by timing of transfusion, postoperative RBCT was associated with shortened RFS and OS. Controlling for age, body mass index, comorbidities, tumor factors, and major complications, each incremental unit of postoperative RBCT was associated with reduced RFS (hazard ratio 1.10, 95% confidence interval 1.02-1.18) and OS (hazard ratio 1.08, 95% confidence interval 1.03-1.12). Low hemoglobin and presence of comorbidities were the only preoperative factors independently associated with RBCT. Conclusions: Allogeneic red blood cell transfusion after PD for PDAC is independently associated with earlier cancer recurrence and reduced survival, in particular when administered postoperatively and in larger quantities. Blood-conservation methods are especially indicated for patients with preoperative anemia and medical comorbidities. Society of Surgical Oncology, 2011 Kneuertz Peter Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Patel Sameer Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Chu Carrie Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Maithel Shishir Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Sarmiento Juan Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Delman Keith Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Staley III Charles Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Kooby David Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut Annals of Surgical Oncology Springer-Verlag 18/5(2011-05-01), 1327-1334 1068-9265 18:5<1327 2011 18 10434 https://doi.org/10.1245/s10434-010-1476-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1476-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kneuertz Peter Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Patel Sameer Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Chu Carrie Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Maithel Shishir Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Sarmiento Juan Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Delman Keith Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Staley III Charles Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 700 1- Kooby David Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/5(2011-05-01), 1327-1334 1068-9265 18:5<1327 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer