Transfusion Alert for Patients with Curable Cancer

Yamashita K, Sakuramoto S, Kikuchi S, Katada N, Kobayashi N, Watanabe M.
World J Surg. 2007 Oct 5; [Epub ahead of print]

Department of Surgery, Kitasato University Hospital, Kitasato 1-15-1, Sagamihara, 228-8555, Kanagawa, Japan, gekaw@med.kitasato-u.ac.jp.

Abstract
BACKGROUND: Perioperative transfusion (POT) is a negative prognostic factor for outcome in cancer patients undergoing surgery, and splenectomy (SPL) has been suggested to help obviate this negative effect. However, the prognostic independence among related factors and clinical significance of the interaction remains elusive. PATIENTS AND METHODS: Between January 1, 1990 and January 31, 2005, a total of 200 patients with proximal gastric cancer classified as having stage IB to III disease after curative resection were enrolled at Kitasato University Hospital in a retrospective manner, according to a previous report by Weitz et al.
FINDINGS: POT was reconfirmed to be a potent univariate prognostic predictor in this model (p < 0.0001). The tendency was further augmented in patients without SPL, suggesting that SPL can counteract the negative aspects of POT. A multivariate analysis including related factors revealed that POT was one of the most potent independent prognostic factors, as were stage and age. Stratification analysis following the JCGC staging system revealed that the outstanding prognostic difference according to POT was recognized in patients anticipated to be cured, such as those with stage IB (p = 0.012) or II (p = 0.003) but not stage III. SPL could dramatically improve the prognosis with POT in stage IB patients but modestly if at all in those with stage II or III. INTERPRETATION: Our findings support the need for a clinical alert against POT throughout the course of cancer treatment, especially for curable disease; thus, POT should be carefully considered from an oncologic point of view. Appropriate strategies to
minimize POT should be urgently developed.

This is old news, albeit important add on. This group didn't facilitate a study that would allow them to give a reason. However, they did add another straw to the back of the transfusion practice camel.

Since 2000 there have been studies that did show perioperative blood transfusions act to suppress the immune system. It was surmised that this exposed the patient to secondary problems and cancer re-occurance.

Perhaps the fact that nitric oxide is not present to help deliver RBC to the tissues has some bearing. Starving cells are weak.

It is frustrating isn't it? We see the gorilla sitting across the table but until we take a DNA sample, send it to the lab and wait for the results all we can say for sure is that our colleague Maggie was beaten to death by a cause of unknown origin. Say it was an 800 pound gorilla and the boys will argue all the way to the funeral.

:-)