Association of perioperative transfusion with survival and recurrence after resection of gallbladder cancer: A 10-institution study from the US Extrahepatic Biliary Malignancy Consortium

• Authors: Alexandra G Lopez-Aguiar, Emory University; Cecilia G Ethun, Emory University; Mia R McInnis, Emory University; Timothy M Pawlik, Johns Hopkins University; George Poultsides, Stanford University; Thuy Thuy, Stanford University; Kamran Idrees, Vanderbilt University; Chelsea A Isom, Vanderbilt University; Ryan C Fields, Washington University; Bradley Krasnick, Washington University; Sharon M Weber, University of Wisconsin; Ahmed Salem, University of Wisconsin; Robert CG Martin, University of Louisville; Charles R Scoggins, University of Louisville; Perry Shen, Wake Forest University; Harveshp D Mogal, Wake Forest University; Carl Schmidt, Ohio State University; Eliza W Beal, Ohio State University; Ioannis Hatzaras, New York University; Rivfka Shenoy, New York University; Kenneth Cardona, Emory University; Shishir Maithel, Emory University
• Journal Title: JOURNAL OF SURGICAL ONCOLOGY
• Volume: Volume 117, Number 8
• Publisher: WILEY | 2018-06-15, Pages 1638-1647
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/jso.25086
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Oncology; Surgery; gallbladder cancer; perioperative blood transfusion; recurrence; survival; BLOOD-TRANSFUSION; CURATIVE RESECTION; COLORECTAL-CANCER; CARCINOMA; OUTCOMES; CHOLECYSTECTOMY; ADENOCARCINOMA; EXPERIENCE; DISEASE

Abstract

Background and Objectives: Perioperative blood transfusion is associated with poor outcomes in several malignancies. Its effect in gallbladder cancer (GBC) is unknown. Methods: All patients with GBC who underwent curative-intent resection at 10-institutions from 2000 to 2015 were included. The effect of blood transfusion on overall survival (OS) and recurrence-free (RFS) was evaluated. Results: Of 262 patients with curative-intent resection for GBC, 61 patients (23%) received blood transfusions. Radical cholecystectomy was the most common procedure (80%), but major hepatectomy was more frequent in the transfusion versus no-transfusion group (13% vs 4%; P = 0.02). The transfusion group was less likely to have incidentally discovered disease (57% vs 74%) and receive adjuvant therapy (29% vs 48%), but more likely to have preoperative jaundice (23% vs 11%), T3/T4 tumors (60% vs 39%), LVI (71% vs 40%), PNI (71% vs 48%), and major complications (39% vs 12%) (all P < 0.05). Transfusion was associated with lower median OS compared to no-transfusion (20 vs 32 mos; P < 0.001), which persisted on multivariable (MV) analysis (HR:1.9; 95%CI 1.1-3.5; P = 0.035), controlling for comorbidities, serum albumin, INR, preoperative jaundice, major hepatectomy, incidental discovery, margin status, T-Stage, LN status, and major complications. Median RFS of transfused patients was 13mo compared to 49mo for non-transfused patients (P = 0.1). Transfusion, however, was an independent predictor of decreased RFS on MV analysis (HR:2.3; 95%CI 1.1-5.1; P = 0.035). Conclusions: Perioperative blood transfusion is associated with decreased OS and RFS after resection for GCC, accounting for other adverse factors. Transfusions should thus be administered with well-defined protocols.