Impact of Perioperative Blood Transfusion on Survival After Radical Gastrectomy in Stage II/III Gastric Cancer

Overview

This retrospective study analyzed 1020 patients with stage II/III gastric cancer undergoing radical gastrectomy to assess the impact of perioperative blood transfusion (BTF) on overall survival (OS) and disease-free survival (DFS). Using propensity score matching to reduce bias, the study found that BTF was associated with poorer OS and DFS, suggesting transfusion may adversely affect long-term outcomes.

Background

Gastric cancer is the fourth most common cancer worldwide and a leading cause of cancer mortality, particularly in China. Radical gastrectomy with D2 lymphadenectomy is the standard curative treatment for advanced stage II/III disease. Many patients present with anemia and may require perioperative blood transfusions due to intraoperative blood loss. While BTF can be life-saving, its impact on oncological outcomes remains controversial, with concerns about transfusion-related immunomodulation and systemic inflammation potentially worsening prognosis.

Data Highlights

Key Findings

• Perioperative blood transfusion was associated with decreased overall survival and disease-free survival in patients undergoing radical gastrectomy for stage II/III gastric cancer.
• Propensity score matching was used to adjust for confounding factors such as age, ASA score, and tumor stage, strengthening the association between BTF and poorer outcomes.
• Transfusion-related immunomodulation and systemic inflammation are proposed mechanisms for the adverse effects of BTF on prognosis.
• Patients receiving BTF often had more advanced disease and complex surgeries, which may contribute to worse outcomes but do not fully explain the association.
• Adjuvant chemotherapy was administered according to standard protocols, but the impact of BTF remained significant after adjustment.

Clinical Implications

Clinicians should carefully weigh the risks and benefits of perioperative blood transfusion in patients undergoing radical gastrectomy for gastric cancer. Strategies to minimize blood loss and optimize preoperative hemoglobin may reduce the need for transfusion. Awareness of the potential negative impact of BTF on survival outcomes should inform perioperative management and patient counseling.

Conclusion

Perioperative blood transfusion is independently associated with poorer overall and disease-free survival following radical gastrectomy in stage II/III gastric cancer. Efforts to limit transfusion may improve long-term oncological outcomes.

References

1. Author/Source/Year -- Impact of Perioperative Blood Transfusion on Overall and Disease-Free Survival Following Radical Gastrectomy in Stage II/III Gastric Cancer: A Propensity Score Matched Study