Effect of Blood Transfusions on Survival after Curative Resection for Advanced Gastric Cancer

Takashi Ichikura, Soichi Tomimatsu, Hideto Ito, Keiichi Iwaya, Keiichi Fujino, Hirotsugu Ikawa, Yasushi Okusa, Shoetsu Tamakuma

Department of Surgery I, National Defense Medical College

The relationship between blood transfusions and prognosis after surgery for gastric cancer was investigated. Patients who underwent curative resection for advanced gastric cancer were divided into three groups based on the volume of perioperative blood transfusions. The patients in the first group received no transfusion, the second group received a transfusion of less than 1000 ml, and the third group received 1000 ml of blood or more. The survival rate for the patients transfused with 1000 ml or more was significantly lower than that for the non-transfused patients (p<0.01). However, there was a difference in depth of cancer infiltration and lymph node involvement between these two groups, which might have been another factor causing the difference in the survival rate. In the patients with cancer infiltration beyond the proper muscle layer, there was a significantly better survival rate for the non-transfused patients than the patients transfused with 1000 ml or more (p<0.01), without any difference in depth of cancer infiltration and lymph node involvement between the two groups. In the patients with cancer infiltration beyond the proper muscle layer, the survival rate was analyzed further by Cox proportional hazard model, in which 11 clinical and pathological factors that could affect the postoperative outcome were chosen as covariates. The factors that were significantly correlated with survival were lymph node involvement, maximum diameter of the tumor, venous invasion, and perioperative blood transfusions. These results indicate that perioperative blood transfusions may have an adverse effect on the prognosis after curative resection for gastric cancer, especially in patients with cancer infiltration beyond the proper muscle layer.

Key words
blood transfusion, gastric cancer, postoperative survival rate, Cox proportional hazard model

Reprint requests
Takashi Ichikura Department of Surgery I, National Defense Medical College
3-2 Namiki, Tokorozawa, 359 JAPAN

Accepted
June 5, 1991

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