Perioperative blood transfusion is associated with the postoperative systemic inflammatory response and poorer outcomes following surgery for colorectal cancer

McSorley, S. T. , Tham, A., Dolan, R. D. , Steele, C. W. , Ramsingh, J., Roxburgh, C. , Horgan, P. G. and McMillan, D. C. (2020) Perioperative blood transfusion is associated with the postoperative systemic inflammatory response and poorer outcomes following surgery for colorectal cancer. Annals of Surgical Oncology, 27, pp. 833-843. (doi: 10.1245/s10434-019-07984-7) (PMID:31664621) (PMCID:PMC7000540)

Abstract

Background: The present study investigated relationships between perioperative blood transfusion, postoperative systemic inflammatory response, and outcomes following surgery for colorectal cancer. Methods: Data were recorded for patients (n = 544) undergoing potentially curative, elective surgery for colorectal cancer at a single center between 2012 and 2017. Transfusion history was obtained retrospectively from electronic records. Associations between blood transfusion, postoperative C-reactive protein (CRP), albumin, hemoglobin, complications, cancer-specific survival and overall survival (OS) were assessed using propensity score matching (n =116). Results: Of 544 patients, the majority were male (n =294, 54%), over 65 years of age (n =350, 64%), and with colonic (n =347, 64%) node-negative disease (n =353, 65%). Eighty-six patients (16%) required perioperative blood transfusion. In the unmatched cohort, blood transfusion was associated with higher median postoperative day (POD) 3 CRP {143 [interquartile range (IQR) 96–221 mg/L] vs. 120 (IQR 72–188 mg/L); p = 0.004}, lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 27 (IQR 24–30 g/L); p < 0.001], more postoperative complications [odds ratio (OR) 3.28, 95% confidence interval (CI) 2.03–5.29] and poorer OS [hazard ratio (HR) 3.18, 95% CI 2.08–4.84]. In the propensity score matched cohort, blood transfusion was similarly associated with higher median POD 3 CRP [130 (IQR 93–196 mg/L) vs. 113 (IQR 66–173 mg/L); p = 0.046], lower median POD 3 albumin [24 (IQR 20–26 g/L) vs. 26 (IQR 24–30 g/L); p < 0.001], more postoperative complications (OR 2.91, 95% CI 1.36–6.20) and poorer OS (HR 2.38, 95% CI 0.99–5.73). Conclusions: Perioperative blood transfusion was associated with postoperative inflammation, complications, and poorer survival in patients undergoing colorectal cancer surgery, with and without propensity score techniques.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and McSorley, Dr Stephen and McMillan, Professor Donald and Steele, Dr Colin and Roxburgh, Professor Campbell and Dolan, Dr Ross
• Authors: McSorley, S. T., Tham, A., Dolan, R. D., Steele, C. W., Ramsingh, J., Roxburgh, C., Horgan, P. G., and McMillan, D. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgical Oncology
• Publisher: Springer
• ISSN: 1068-9265
• ISSN (Online): 1534-4681
• Published Online: 29 October 2019
• Copyright Holders: Copyright © 2019 The Authors
• First Published: First published in Annals of Surgical Oncology 27:833-843
• Publisher Policy: Reproduced under a Creative Commons License