Autologous Blood Transfusion for Esophageal Cancer Treated with Chemoradiotherapy Followed by Esophagectomy

Matsuo Nagata, Takehide Asano, Hiroshi Yamamoto, Nobuhiro Takiguchi, Osamu Kainuma, Hiroaki Sohda, Mikito Mori, Kentaro Murakami, Kazuo Watanabe and Chikara Sakai*

Division of Gastroenterological Surgery and Transfusion Division*, Chiba Cancer Center Hospital

Purpose: Autologous blood transfusion has been shown to be useful as a means of avoiding the problems associated with allogeneic transfusion, such as transmission of bacteria and viruses, and immunological reactions, such as allergy, graft-versus-host disease, and suppression of tumor immunity. This study retrospectively investigated the usefulness of autologous blood donation in esophageal cancer treated by chemoradiotherapy (CRT) followed by surgery. Patients and Methods: Between June 2000 and October 2003, 59 patients with resectable esophageal cancer were treated by preoperative CRT, consisting of 5FU 700-800 mg/m² days 1-5, Nedaplatin 80 mg/m² (or Cisplatin 70 mg/m²) day 1, and 30 Gy of radiation days 1-19. The criteria for autologous blood donation were: Hb value greater than 11 g/dl, body weight greater than 40 kg, and having obtained informed consent in writing. Autologous blood was collected 1 and 2 weeks before surgery, and erythropoietin was injected on the day of each blood donation. Esophagectomy was performed by right thoracotomy and laparotomy, and a cervical or intrathoracic anastomosis was created between the esophagus and gastric tube by the stapling technique. The autologous blood donor (ABD) group was compared with a non-autologous blood donor (NABD) group who were treated by the same preoperative CRT schedule and satisfied the criteria for autologous blood donation between Aug 1998 and May 2000. Results: The Hb value of 49 (83.1%) of the 59 patients treated by preoperative CRT was higher than 11 g/dl, and 400-800 ml (mean 662.2±158.5 ml) of autologous blood was successfully collected from the 45 patients (76.3%) who weighed more than 40 kg. Allogeneic blood transfusion during the perioperative period was avoided in only 1 patient (9.1%) in the NABD group. In the ABD group, on the other hand, allogeneic blood products, including MAP, FFP and PPF, were avoided in 36 patients (83.7%). There were no significant differences between the two groups in postoperative complications or Hb, serum total protein, and albumin values. Conclusion: These results indicate that autologous blood donation is useful as a means of avoiding allogeneic blood transfusion in esophageal cancer patients treated by preoperative CRT and surgery.

Key words
autologous blood transfusion, esophageal cancer, chemoradiotherapy

Reprint requests
Matsuo Nagata Division of Gastroenterological Surgery, Chiba Cancer
Center
666-2 Nitona-cho, Chiba-city, 260-8717 JAPAN

Accepted
January 26, 2005

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